title: Primary hypertension at a single center: treatment, time  to control, and extended follow-up.
abstract: We present data on presentation, treatment, and follow-up of 65 pediatric patients with primary hypertension treated over the past 12 years, including initial anthropometric data, pharmacologic treatment, time to control for both systolic and diastolic blood pressure (SBP/DBP), and maintenance of control over time. Data was normalized to standard deviation scores (SDS) for mathematical analysis, and antihypertensive medication dosages were converted to dosage equivalents for a single member of each antihypertensive class. We used multiple regression analysis and Kaplan- Meier survival curves to determine the time to control, medication, and dose effectiveness. Patients were seen for an average of seven visits over 25 months. Initial BPs averaged 134/71 mmHg (2.1/0.6 SDS). Patients were taller, heavier, and had higher body mass index than average for age and sex. By the fourth visit, SBP was <90th percentile in 79%. Ninety percent could be controlled, although 32 lost control at some point (at least 16 due to noncompliance). At the last visit, 46 were controlled, and 5/8 patients off medication remained normotensive. Only angiotensin-converting enzyme inhibitors and beta-blockers demonstrated significant association with BP control. This is the first study to document the time to control of BP, and it can serve as an initial standard for quality assessment.
authors.affiliation: Department of Pediatrics, The Penn State College of Medicine, The Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: DiPietro
authors.forename: Deborah
authors.initials: D
authors.lastname: Kees-Folts
authors.forename: Susan
authors.initials: S
authors.lastname: DesHarnais
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Steven Joel
authors.initials: SJ
authors.lastname: Wassner
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D055118:Medication Adherence; D010349:Patient Compliance; D011320:Primary Health Care; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers