High blood pressure or hypertension is often called a silent killer because its symptoms are not always noticeable, but it can lead to potentially deadly problems. In a study in this week's Journal of the American Medical Association (JAMA), MetroHealth physicians used electronic medical records to examine the charts of 14,000 children. They discovered hypertension was undiagnosed in three-quarters of the pediatric patients.
High blood pressure, which is thought to affect 2 to 5 percent of children, is increasing in prevalence with the pediatric obesity epidemic. Diagnosing hypertension in children is much more difficult than the simple blood pressure check required in adults, because abnormal blood pressures in children vary with age, sex, and height.
David Kaelber M.D., PhD., internist and pediatrician, The MetroHealth System and senior instructor at Case Western Reserve University, and fellow researchers found that 507 of the 14,000 children or 3.6% met the criteria for hypertension, but only 131 or 26% had a diagnosis of hypertension or high blood pressure documented in their electronic medical record. Kaelber says this could mean as many as 1.5 million children nationwide have high blood pressure and are going undiagnosed.
"This is a warning for pediatricians everywhere," Kaelber said. "We're often focused on what brought our patients into our office instead of the bigger picture. We take the time to get a blood pressure reading during the visit. By reviewing several blood pressure readings over time through the electronic medical records, we may be able to pinpoint hypertension at an earlier age, possibly heading off chronic problems, such as heart disease and stroke, in adulthood."
The researchers examined the records of 14,187 children and adolescents, ages 3-18, who were seen at least three times for well-child care between June 1999 and September 2006 in outpatient clinics at MetroHealth. Hypertension was defined using the standard definition of having 3 or more abnormal blood pressure measurements meeting high blood pressure criteria. MetroHealth was one of the early medical centers nationwide to have entirely paperless outpatient visits through an electronic medical record.
"Although this study identifies the problem of undiagnosed hypertension in children, it also points to the potential of electronic medical records to help address this issue," the authors write in JAMA. "The relatively poor identification of abnormal blood pressure could be remedied by a clinical decision support algorithm built into an electronic medical record that would automatically review current and prior blood pressures, ages, heights, and sex to determine if abnormal blood pressure criteria had been met. The algorithm could indicate if any abnormal blood pressure ... already existed and prompt the pediatric clinician that the child appears to have undiagnosed abnormal blood pressure. In addition, the clinical decision support algorithm could provide guideline-based evaluation, treatment, and parent/patient education materials to the clinician."
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