Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep;39(9):2725-2732.
doi: 10.1007/s00467-024-06404-7. Epub 2024 May 18.

Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring - characteristics associated with inertia and action

Evelien van Gelderen  1 , Kevin J Psoter  1 , Rafi Faria  1 , Cozumel Pruette  1 , Tammy M Brady  2
Affiliations

Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring - characteristics associated with inertia and action

Evelien van Gelderen et al. Pediatr Nephrol. 2024 Sep.

Abstract

Background: Ambulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings.

Methods: This was a retrospective cross-sectional analysis of patients 5-22 years old who underwent 24-h ABPM between 2003-2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action.

Results: 115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action.

Conclusions: While most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized.

Keywords: Adolescents; Cardiovascular disease; Children; Clinical decision-making; Hypertension.

PubMed Disclaimer

References

    1. CDC (2022) Heart disease facts. https://www.cdc.gov/heartdisease/index.htm
    1. Candelino M, Tagi VM, Chiarelli F (2022) Cardiovascular risk in children: a burden for future generations. Ital J Pediatr 48:57. https://doi.org/10.1186/s13052-022-01250-5 - DOI - PubMed - PMC
    1. de Ferranti SD, Steinberger J, Ameduri R et al (2019) Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association. Circulation 139:e603–e634. https://doi.org/10.1161/CIR.0000000000000618 - DOI - PubMed
    1. Song P, Zhang Y, Yu J et al (2019) Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr 173:1154–1163. https://doi.org/10.1001/jamapediatrics.2019.3310 - DOI - PubMed - PMC
    1. Gallibois CM, Jawa NA, Noone DG (2017) Hypertension in pediatric patients with chronic kidney disease: management challenges. Int J Nephrol Renovasc Dis 10:205–213. https://doi.org/10.2147/IJNRD.S100891 - DOI - PubMed - PMC

MeSH terms

Substances

LinkOut - more resources