title: Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children.
abstract: OBJECTIVE
  The goal was to determine patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure (BP) in children. We hypothesized that being of healthy weight, having a BP of <120/80 mmHg, and being seen by a less experienced provider would result in decreased recognition.
  
  
  METHODS
  A cross-sectional study of clinic visits for children 3 to 20 years of age at an urban, pediatric primary care practice between January 1, 2006, and June 30, 2006, was performed. Children with elevated systolic or diastolic BP (> or = 90th percentile or > or = 120/80 mmHg) were included. Recognition was defined as having any of the following documented: repeat BP measurement, elevated-BP/hypertension diagnosis, plan to recheck BP, or initiation of hypertension evaluation. Multivariate logistic regression analysis was used to identify characteristics associated with underrecognition.
  
  
  RESULTS
  Elevated BP occurred in 779 (39%) of 2000 visits. Of 726 cases included in the analysis, 87% were not recognized by providers. Patient-level predictors of underrecognition included systolic BP of <120 mmHg (odds ratio: 7.7 [95% confidence interval: 3.2-18.6]), diastolic BP of <80 mmHg (odds ratio: 2.4 [95% confidence interval: 1.1-5.0]), decreasing BMI z score, male gender, older age, lack of family history of cardiovascular disease, and negative medical history findings. Being seen by a nurse practitioner and being seen by a less-experienced provider also were significant predictors.
  
  
  CONCLUSIONS
  Most BP elevations were not recognized by providers. Poor recognition was most influenced by the absence of obviously elevated BP, obesity, and family history of cardiovascular disease.
authors.affiliation: MHS, Johns Hopkins University, David M. Rubenstein Child Health Building, 200 North Wolfe St, Room 3057, Baltimore, MD 21287, USA. tbrady8@jhmi.edu
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Brady
authors.forename: Barry S
authors.initials: BS
authors.lastname: Solomon
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Neu
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D016015:Logistic Models; D009722:Nurse Practitioners; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055815:Young Adult