Failure to confirm high blood pressures in pediatric care-quantifying the risks of misclassification

Abstract

Pediatric practice guidelines call for repeating an elevated office blood pressure (BP) at the same visit, but there are few data available to support this recommendation. We compared the visit results in children aged 3 to 17 years with a BP reading ≥95th percentile (n = 186 732) based on the initial BP and the mean of two BP readings, using electronic medical records from 2012-2015. Failure to repeat an initial BP reading ≥95th percentile would lead to a false "hypertensive" visit result in 54.1% of children who would require follow-up visits. After an initial visit result indicating hypertension, hypertension stage I or stage II was sustained in 2.3% and 11.3% of youth during their next visits, respectively. In conclusion, only approximately half of the pediatric patients would be correctly classified based on their initial BP. The recommendation to repeat high BP during the same visit needs to be emphasized because it saves unnecessary follow-up visits.

Keywords: blood pressure; children; guidelines; hypertension; screening.

Figure 1

Visit result classification of pediatric patients with blood pressure (BP) indicating hypertension stage I or II based on the initial BP reading compared with the mean of two blood pressure readings. N/A indicates not available.

Figure 2

Hypertension status in pediatric patients with an initial visit indicating hypertension (HTN) stage I or stage II after completing their follow‐up visits.