title: Therapeutic inertia: underdiagnosed and undertreated hypertension in children participating in the T1D Exchange Clinic Registry.
abstract: OBJECTIVE
  Reduction of cardiovascular risk in children with type 1 diabetes requires aggressive management of hypertension (HTN). However, the frequency of diagnosing and effectively treating HTN in youth with type 1 diabetes has not been established. To address this question, we used the data collected in >9000 youth with type 1 diabetes who enrolled in the T1D Exchange Clinic Registry.
  
  
  METHODS
  This analysis included data from medical records of 9362 individuals with enrolment and 1-yr follow-up visits (age 3 to <18 yr, disease duration ≥ 1 yr at follow-up). Data included the prevalence of a documented diagnosis of HTN, elevated blood pressure (BP) (systolic or diastolic ≥95th percentile for age, gender, and height), and treatment with angiotensin converting enzyme (ACE)-receptor inhibitor (ACE-I)/angiotensin receptor blocker (ARB) therapy.
  
  
  RESULTS
  HTN was diagnosed in only 1% (113/9362) of participants; yet, elevated BP was recorded at one of the two visits in 17% and at both visits in 4%. Among those with diagnosed HTN, only 52% (59/113) were receiving ACE-I/ARB therapy and only 32% (19 of 59) of those treated were at goal BP. Children with diagnosed HTN had higher HbA1c (adjusted p < 0.001) and higher BMI (p < 0.001) when compared with children without HTN.
  
  
  CONCLUSIONS
  HTN is likely under diagnosed and undertreated even in pediatric diabetes clinics. The relatively low proportion of hypertensive children receiving ACE-I therapy and reaching BP goals probably identifies an important area for improving care in children with type 1 diabetes.
authors.affiliation: University of Florida, Gainesville, FL, USA.
authors.forename: Bimota
authors.initials: B
authors.lastname: Nambam
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: DuBose
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Nathan
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA.
authors.forename: R Paul
authors.initials: RP
authors.lastname: Wadwa
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Foster
authors.affiliation: Jaeb Center for Health Research, Tampa, FL, USA.
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Miller
authors.affiliation: University of Florida, Gainesville, FL, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Haller
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents
keywords: complications of diabetes mellitus; diagnosis; hypertension; type 1 diabetes mellitus