Pediatric Hypertension Specialists' Perspectives About Adolescent Hypertension Management: Implications for Primary Care Providers.
BACKGROUND
The current specialty-centric hypertension paradigm is unsustainable given the high prevalence of primary hypertension in adolescents.


OBJECTIVE
To describe specialists' perspectives on referral and comanagement for adolescents with hypertension.


METHODS
Cross-sectional mailed survey of a national sample of 397 pediatric cardiologists and 389 pediatric nephrologists, conducted January to May 2014.


RESULTS
Response rate was 61%. Both specialties agreed that primary care providers can make the hypertension diagnosis, try lifestyle changes, and comanage monitoring of patient blood pressure control and medication side effects, but they felt antihypertensive medication use should mainly occur in the specialty setting.


CONCLUSIONS
Our study suggests specialist support for changing the hypertension paradigm to encourage primary care providers, in collaboration with specialists, to diagnose hypertension, initiate lifestyle changes, and monitor progress and side effects. Future work should focus on supporting primary care physician comanagement of adolescents with hypertension.
University of Michigan, Ann Arbor, MI, USA est@med.umich.edu.
Esther
E
Yoon
University of Michigan, Ann Arbor, MI, USA.
Brigitte
B
McCool
University of Michigan, Ann Arbor, MI, USA.
Stephanie
S
Filipp
University of Michigan, Ann Arbor, MI, USA.
Albert
A
Rocchini
University of Michigan, Ann Arbor, MI, USA.
David
D
Kershaw
University of Michigan, Ann Arbor, MI, USA.
Sarah
S
Clark
D000293:Adolescent; D002309:Cardiology; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007400:Interprofessional Relations; D009398:Nephrology; D010372:Pediatrics; D058007:Physicians, Primary Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires
adolescents; cardiology; comanagement; hypertension; nephrology; primary care; referral practices