title: Antihypertensive prescribing patterns for adolescents with primary hypertension.
abstract: BACKGROUND
  Hypertension is an increasingly common problem in adolescents yet current medical management of primary hypertension in adolescents has not been well-described.
  
  
  METHODS
  We identified adolescents with primary hypertension by International Classification of Diseases, Ninth Revision codes and looked at prescription patterns chronologically for antihypertensive drug class prescribed and the specialty of prescribing physician. We also examined patient demographics and presence of obesity-related comorbidities.
  
  
  RESULTS
  During 2003-2008, there were 4296 adolescents with primary hypertension (HTN); 66% were boys; 73% were aged 11 to 14 years; 53% were black, 41% white, and 4% Hispanic; and 48% had obesity-related comorbidity. Twenty-three percent (977) received antihypertensive prescription. White subjects (odds ratio [OR]: 1.61; confidence interval [CI]: 1.39-1.88), older adolescents (≥15 years, OR: 2.11; CI: 1.79-2.48), and those with comorbidity (OR: 1.57; CI: 1.36-1.82) were more likely to receive antihypertensive prescriptions controlling for gender and years of Medicaid eligibility in logistic regression. Angiotensin converting enzyme inhibitors were the most frequently prescribed monotherapy. Nearly two-thirds of adolescents received prescriptions from adult primary care physicians (PCPs) only. More than one-quarter of adolescents who received a prescription received combination therapy, which was most often prescribed by adult PCPs.
  
  
  CONCLUSIONS
  Adult PCPs were the leading prescribers of antihypertensives for adolescents with primary HTN. Race differences exist in physicians' prescribing of antihypertensives to adolescents with primary HTN. The choice of antihypertensives by physicians of different specialties warrants additional study to understand the underlying rationale for treatment decisions and to determine treatment effectiveness.
authors.affiliation: Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, 300 N Ingalls St, Room 6E07, Ann Arbor, MI 48109-5456, USA. est@med.umich.edu
authors.forename: Esther Y
authors.initials: EY
authors.lastname: Yoon
authors.forename: Lisa
authors.initials: L
authors.lastname: Cohn
authors.forename: Albert
authors.initials: A
authors.lastname: Rocchini
authors.forename: David
authors.initials: D
authors.lastname: Kershaw
authors.forename: Gary
authors.initials: G
authors.lastname: Freed
authors.forename: Frank
authors.initials: F
authors.lastname: Ascione
authors.forename: Sarah
authors.initials: S
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008484:Medicaid; D014481:United States
chemical_list: D000959:Antihypertensive Agents