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J Clin Hypertens (Greenwich). 2011;13:767–773. ©2011 Wiley Periodicals, Inc.

The authors measured the percentage of children aged 6 through 17 whose blood pressure (BP) was not measured during recent nonemergency clinical examination and assessed the relative importance of health, ability-to-pay, language, and race-ethnic factors in determining whether BP was measured. Using a pooled dataset from the Medical Expenditure Panel Survey (MEPS) for 2006 and 2007, the authors calculated the percentage of children whose BP was not measured using a sample of children aged 6 through 17 and constructed a logistic regression model to estimate the relative importance of health, economic, and social factors in the examiner’s decision to measure BP. A total of 28.9% of children did not have their BP measured. Within this unmeasured group, 31% had a family history of hypertension, 9% had a family history of diabetes, and 5% had a body mass index ≥32 kg/m2. The logistic regression model of examiners’ decisions indicates that social and economic factors strongly compete with health factors in determining which children not to measure. While examiners place many children at risk for hypertension in the measured pool, they also place many at-risk children in the unmeasured pool for economic and social reasons.