title: Hypertension screening during ambulatory pediatric visits in the United States, 2000-2009.
abstract: OBJECTIVE
  Hypertension occurs in 2% to 5% of children in the United States, and its prevalence has increased during the obesity epidemic. There is no consensus among professional organizations about how frequently blood pressure should be measured in children >3 years old. The purpose of this study was to estimate the frequency of hypertension screening during ambulatory pediatric visits in the United States and to determine patient- and provider-level factors associated with screening during visits specifically for preventive care.
  
  
  METHODS
  We analyzed data from a nationally representative sample of ambulatory visits by using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2000 through 2009. In the subset of visits involving patients aged 3 to 18 years, we estimated the frequency of screening during all visits, preventive visits, and preventive visits in which overweight/obesity was diagnosed. We used multivariable logistic regression to identify patient- and provider-level factors associated with screening.
  
  
  RESULTS
  Hypertension screening occurred during 35% of ambulatory pediatric visits, 67% of preventive visits, and 84% of preventive visits in which overweight/obesity was diagnosed. Between 2000 and 2009, the frequency of screening increased in all visits and in preventive visits. Factors independently associated with screening included older age and overweight/obesity diagnosis.
  
  
  CONCLUSIONS
  Providers do not measure blood pressure in two-thirds of pediatric visits and one-third of pediatric preventive visits. Providers may understand the importance of screening among overweight/obese children; however, efforts to encourage routine screening, particularly in young children, may be needed.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Shapiro
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sutherland
authors.forename: Anisha I
authors.initials: AI
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000175:diagnosis; D050177:Overweight / Q000150:complications / Q000175:diagnosis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States