Recognition of Elevated Blood Pressure in an Outpatient Pediatric Tertiary Care Setting

  • Author Footnotes
    ∗ Current address: Medical College of Wisconsin/Children's Hospital of Wisconsin Pediatric Residency Program, Milwaukee, WI.
    Daniel R. Beacher
    Footnotes
    ∗ Current address: Medical College of Wisconsin/Children's Hospital of Wisconsin Pediatric Residency Program, Milwaukee, WI.
    Affiliations
    University of Minnesota Medical School, Minneapolis, MN

    Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL
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  • Sheila Z. Chang
    Affiliations
    University of Illinois College of Medicine at Chicago, Chicago, IL
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  • Author Footnotes
    Current address: Rush Medical College, Chicago, IL.
    Joshua S. Rosen
    Footnotes
    † Current address: Rush Medical College, Chicago, IL.
    Affiliations
    Northwestern University, Evanston, IL
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  • Author Footnotes
    Current address: Child & Adolescent Health Associates, Ltd., Chicago, IL.
    Genna S. Lipkin
    Footnotes
    ‡ Current address: Child & Adolescent Health Associates, Ltd., Chicago, IL.
    Affiliations
    Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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  • Author Footnotes
    § Current address: Blue Cross Blue Shield Association, Chicago, IL.
    Megan M. McCarville
    Footnotes
    § Current address: Blue Cross Blue Shield Association, Chicago, IL.
    Affiliations
    Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Maheen Quadri-Sheriff
    Affiliations
    Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Soyang Kwon
    Affiliations
    Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL
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  • Jerome C. Lane
    Affiliations
    Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Helen J. Binns
    Affiliations
    Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL

    Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL

    Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Adolfo J. Ariza
    Correspondence
    Reprint requests: Adolfo J. Ariza, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 157, Chicago, IL, 60611-2605.
    Affiliations
    Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL

    Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
    Search for articles by this author
  • Author Footnotes
    ∗ Current address: Medical College of Wisconsin/Children's Hospital of Wisconsin Pediatric Residency Program, Milwaukee, WI.
    Current address: Rush Medical College, Chicago, IL.
    Current address: Child & Adolescent Health Associates, Ltd., Chicago, IL.
    § Current address: Blue Cross Blue Shield Association, Chicago, IL.

      Objective

      To assess the prevalence of elevated blood pressure (BP) and its identification among outpatients at a pediatric tertiary care hospital and to assess clinician attitudes towards BP management.

      Study design

      A retrospective review was undertaken of electronic medical record data of visits over the course of 1 year to 10 subspecialty divisions and 3 primary care services at an urban tertiary care hospital. Interviews of division/service representatives and a clinician survey on perceived role on BP care, practices, and protocols related to BP management were conducted. Elevated BP was defined as ≥90th percentile (using US references); identification of elevated BP was defined as the presence of appropriate codes in the problem list or visit diagnoses.

      Results

      Among 29 000 patients (ages 2-17 years), 70% (those with ≥1 BP measurement) were analyzed. Patients were as follows: 50% male; 42% white, 31% Hispanic, 16% black, 5% Asian, and 5% other/missing; 52% had Medicaid insurance. A total of 64% had normal BPs, 33% had 1-2 elevated BP measurements, and 3% had ≥3 elevated BP measurements. Among those with ≥3 elevated BP measurements, the median frequency of identification by division/service was 17%; the greatest identification was for Kidney Diseases (67%), Wellness & Weight Management (60%), and Cardiology (33%). Among patients with ≥3 elevated BP measurements, 21% were identified vs 7% identified among those with 1-2 increased measurements ( P < .001). All clinician survey respondents perceived self-responsibility for identification of elevated BP, but opinions varied for their role in the management of elevated BP.

      Conclusions

      The identification of patients with elevated BP measurements was low. Strategies to increase the identification of elevated BPs in outpatient tertiary care settings are needed.
      BMI ( Body mass index), BP ( Blood pressure), EMR ( Electronic medical record), ICD-9 ( International Classification of Disease, 9th Revision), NHLBI ( National Heart, Lung, and Blood Institute)
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