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Kids' High Blood Pressure Often Missed

Study Shows Doctors May Be Underdiagnosing Hypertension in Children
WebMD Health News
Reviewed by Louise Chang, MD

Aug. 21, 2007 -- High blood pressure in children and teens appears increasingly common, but it frequently goes undiagnosed, according to new research.

Three out of four children in the study who were found to have high blood pressure also had no previous diagnosis of the disorder. Only one in 10 children with borderline high blood pressure, or pre-hypertension, had a prior diagnosis.

The study is published in the Aug. 22/29 edition of The Journal of the American Medical Association.

Children who were not obese, not tall for their age, or were younger were most likely to have their high blood pressure missed during previous medical visits.

Diagnosing high blood pressure in children and adolescents is more complicated than in adults. It involves an evaluation that takes into account the child's age, sex, and height -- and at least three high readings during separate visits.

Researcher Matthew L. Hansen, MD, tells WebMD that pediatricians and family doctors often have a very low suspicion of high blood pressure in children who do not have obvious risk factors like obesity.

"High blood pressure isn't necessarily on the minds of pediatric clinicians," he says. "It is also much more difficult to know if a child's blood pressure is abnormal because there is not a set cutoff like there is with adults."

Kids With High Blood Pressure

It is estimated that between 2% and 5% of children and adolescents have high blood pressure, but this figure may climb higher as obesity becomes more prevalent in this age group.

In addition to obesity, conditions such as kidney disease can increase a child's risk for high blood pressure.

In an effort to better understand the incidence of undiagnosed high blood pressure among children and teens, Hansen and colleagues from Cleveland's Case Western Reserve University reviewed the medical records of 14,187 patients between the ages of 3 and 18 enrolled in an Ohio-based health plan.

All of the children saw their doctor for well-child visits at least three separate times between the summer of 1999 and the fall of 2006, and all had electronically accessible medical records.

Of the 507 cases of high blood pressure identified by the researchers through examination of the electronic data, only 131 (26%) had been previously identified. And just 55 (11%) of the 485 children and teens with pre-hypertension had a previous diagnosis of higher-than-normal blood pressure.

Obese children were less likely to have their high blood pressure go undiagnosed than normal-weight children, presumably because doctors had a higher suspicion of the disorder in overweight patients, Hansen says.

Underdiagnosis was also less of an issue among the oldest and tallest kids in the study because their normal and high blood pressure readings were more likely to mirror those of adults.

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