A simplified table improves the recognition of paediatric hypertension.
OBJECTIVE
Unrecognised and untreated hypertension can lead to significant morbidity and mortality over time. In a 2003 chart review, we found that our providers only recognised 15% of hypertensive blood pressure (BP). Our objective was to determine whether a simplified BP table improves the recognition of elevated BP in children.


METHODS
We developed a simplified BP table for children 3-18 years and posted it in provider work areas beginning August 2006. We reviewed a retrospective sample of well visits for children aged 3-18 years, with equal numbers by sex and year of age, presenting at a university-based paediatric clinic between January and August 2007. Visit notes for all children with elevated BP values ≥ 90th percentile were reviewed to identify whether the provider recognised that the BP was elevated.


RESULTS
In 493 well visits, 85 (17.2%) children had pre-hypertensive (90th to < 95th percentile) and 100 (20.3%) had hypertensive (≥ 95th percentile) BP values. Providers recognised elevations in 34 (40%) pre-hypertensive and 77 (77%) hypertensive measurements. Recognition was significantly more common for those in the hypertensive than the pre-hypertensive range (χ² = 24.9, degrees of freedom= 1, P < 0.001). Compared with our 2003 data, recognition of hypertensive BP values was significantly greater (77% vs. 15%) (t = 14.479, degrees of freedom = 98, P <0.001) after introduction of the simplified BP table.


CONCLUSIONS
Use of a simplified BP table can lead to significantly improved recognition of elevated BP in children.
Mitchell
Charlene K
CK
Department of Internal Medicine, University of Louisville, School of Medicine, Louisville, Kentucky 40202, USA. ckmitc01@louisville.edu
Theriot
Judith A
JA
Sayat
Jonathan G
JG
Muchant
Dianne G
DG
Franco
Sofia M
SM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008485:Medical Audit; D010372:Pediatrics / Q000379:methods* / Q000592:standards; D058246:Prehypertension / Q000175:diagnosis*; D012015:Reference Standards; D012189:Retrospective Studies