A simplified table improves the recognition of paediatric hypertension


Dr Charlene K Mitchell, Departments of Internal Medicine and Pediatrics, University of Louisville, 3rd Floor Ambulatory Care Building, 550 S. Jackson Street, Louisville, KY 40202, USA. Fax: +502 852 8980; email: ckmitc01@louisville.edu


Aim:  Unrecognised and untreated hypertension can lead to significant morbidity and mortality over time. In a 2003 chart review, we found that our providers only recognised 15% of hypertensive blood pressure (BP). Our objective was to determine whether a simplified BP table improves the recognition of elevated BP in children.

Methods:  We developed a simplified BP table for children 3–18 years and posted it in provider work areas beginning August 2006. We reviewed a retrospective sample of well visits for children aged 3–18 years, with equal numbers by sex and year of age, presenting at a university-based paediatric clinic between January and August 2007. Visit notes for all children with elevated BP values ≥90th percentile were reviewed to identify whether the provider recognised that the BP was elevated.

Results:  In 493 well visits, 85 (17.2%) children had pre-hypertensive (90th to <95th percentile) and 100 (20.3%) had hypertensive (≥95th percentile) BP values. Providers recognised elevations in 34 (40%) pre-hypertensive and 77 (77%) hypertensive measurements. Recognition was significantly more common for those in the hypertensive than the pre-hypertensive range (χ2 = 24.9, degrees of freedom = 1, P < 0.001). Compared with our 2003 data, recognition of hypertensive BP values was significantly greater (77% vs. 15%) (t = 14.479, degrees of freedom = 98, P < 0.001) after introduction of the simplified BP table.

Conclusions:  Use of a simplified BP table can lead to significantly improved recognition of elevated BP in children.