Purpose To determine whether pediatric providers recognize elevated blood pressures. The hypothesis is that fewer than 50% of elevated blood pressure values in children are recognized.
Methods Children aged 3 to 17 years presenting for well visits at two university-based pediatric clinics, from July 31 to August 15, 2003, were included. Height, weight, and systolic blood pressures (SBP) and diastolic (DBP) were obtained. Height and body mass index (BMI) percentiles were determined. Using current table-based standards, SBP and DBP values were categorized as normal (< 90th %), borderline (90% to 94%), or hypertensive (95% or higher). Statistical analysis was done using chi-square test for dichotomous and the Student t-test for continuous variables with p values ≤ .05 considered significant.
Results Of the 287 children, 161 (56.1%) had normal BP; 35 (12.2%) were borderline; and 90 (31.4%) were in the hypertensive range. The mean BMI was significantly higher (79%) for children in the hypertensive than in the normotensive (60%) range (p < .001). Only 13 (14.6%) with hypertensive BP were identified as elevated, which is significantly less than 50% recognition (p < .001). The mean BMI percentile was 92 for those recognized compared to 76 for those with unrecognized BP elevations (p = .001).
Conclusions While it is likely that most elevated blood pressures obtained in the pediatric office do not represent hypertension, the diagnosis of hypertension is dependent upon the recognition of abnormal values. Given the current complexity for determining hypertension, it is not surprising that only 11% of elevated BP were recognized in this study. Hypertensive values in normal-weight children were recognized significantly less often than in the children with higher BMI percentiles. Future efforts should be directed towards developing a simpler definition of pediatric hypertension, one that is preferably based on the pathophysiological consequences than on statistical patterns.