title: Hypertension screening and follow-up in children and adolescents in a Canadian primary care population sample: a retrospective cohort studystudy.
abstract: BACKGROUND
  Uncertainty exists about the need to screen for hypertension in children and adolescents. Information on current screening and follow-up rates in Canadian community practices is not available. There are no Canadian guidelines on the subject. We sought to identify current rates of pediatric hypertension screening and follow-up in Canada. In addition, we examined patient and provider characteristics associated with rates of blood pressure screening.
  
  
  METHODS
  We used electronic medical record data extracted on Apr. 1, 2013, from 79 family practices in Toronto. We identified children seen at least twice between the ages of 3 and 18 years, with at least 6 months between first and last encounter. We used Multivariate Poisson regression analysis to analyze variation in blood pressure measurement rates and associations with patient and physician factors.
  
  
  RESULTS
  We identified 5996 children (62% of 9667 in total) who had at least 1 blood pressure measurement recorded. Of these children, 14% had at least 1 abnormal blood pressure measurement, and of those children, only 5% had a follow-up measurement recorded within 6 months. After adjustment, increases in rates of blood pressure measurements were associated with greater number of encounters (rate ratio [RR] = 1.03, 95% confidence interval [CI] 1.02-1.04, p < 0.001), older age at first encounter (RR = 1.06, 95% CI 1.03-1.10, p = 0.002), and female sex (RR = 1.12, 95% CI 1.03-1.20, p = 0.006). Obesity or a recorded family history of hypertension were not associated with more blood pressure measurements. Female physicians recorded more blood pressure measurements than did male physicians (RR = 1.41, 95% CI 1.04-1.89, p = 0.02).
  
  
  CONCLUSIONS
  This screening measure was frequently done and appeared to be incompletely followed up. Clear guidance is needed; guideline developers should consider reviewing this topic.
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: Babak
authors.initials: B
authors.lastname: Aliarzadeh
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: David
authors.initials: D
authors.lastname: White
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: Catherine
authors.initials: C
authors.lastname: Birken
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: Patricia
authors.initials: P
authors.lastname: Parkin
authors.affiliation: University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.
authors.forename: Michelle
authors.initials: M
authors.lastname: Greiver