Hypertension is a common chronic disease with an estimated prevalence of ~3.5% in children. Hypertension during childhood has been shown to be an independent risk factor for hypertension in adulthood, as well as an early marker of cardiovascular disease. With the increasing prevalence of childhood obesity, a correlated condition, childhood hypertension has also become a increasingly prominent concern for pediatric physicians. Unfortunately, childhood hypertension remains grossly underdiagnosed. A 2007 cohort study of children in a large academic urban hospital system in Ohio found that only 26% of the children who met hypertension criteria were correctly identified in the electronic medical record. This failure to correctly diagnose children with hypertension is not due to physicians' collective lack of awareness of the possibility of hypertension, but rather due to barriers in making the diagnosis; which include a lack of knowledge of normal blood pressure ranges for children and lack of accessibility to patients' previous blood pressures.
The three major stages of hypertension are, from least to most severe: elevated blood pressure (previously known as prehypertension), stage 1 hypertension, and stage 2 hypertension. A correct hypertension diagnosis is made when three blood pressure measurements taken at separate times are compared against a table of normal blood pressure measurements. Normal blood pressure in children is determined using a function that considers age, sex, and height percentile.
In order to make a hypertension diagnosis, Hyperisk must read in at least three data points of blood pressure as well as age and height data, then calculate the corresponding blood pressure percentiles and then follow specific logic to suggest a diagnosis. Height percentiles are calculated using CDC normative data charts. The conversion from blood pressure to percentile and the logic behind the suggested diagnosis is based on the "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents".
Peer-reviewed journal articles:
Overweight, ethnicity, and the prevalence of hypertension in school-aged children
Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RF
Pediatrics 2004 113(3 pt 1):475-482
Body mass index and blood pressure screening in a rural public school system: the Healthy Kids Project
Moore WE, Stephens A, Wilson T, Wilson W, Eichner JE
Prev Chronic Dis 2006 3(4):A114
Underdiagnosis of Hypertension in Children and Adolescents
Hansen ML, Gunn PW, Kaelber DC
JAMA 2007 298(8):874-879
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents
Pediatrics 2004 114:555-576
Office of Information Services. Growth Charts - 2000 CDC Growth Charts
Center for Disease Control/National Center for Health Statistics 9 September 2010
Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents
Pediatrics 2017 140(3):e20171904
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