You Can't Treat a Problem if You Don't Recognize It.

Abstract

* Abbreviations: AAP — : American Academy of Pediatrics BP — : blood pressure CDS — : clinical decision support In 2004, The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents was released by the National Institutes of Health1 with the intention of providing a clear set of guidelines to help clinicians identify and treat childhood hypertension. Despite the increased attention paid to childhood hypertension since then, most children and adolescents with elevated blood pressure (BP) still go unrecognized and undiagnosed during clinical encounters.2,3 There are likely many contributing factors that lead to the underrecognition of pediatric hypertension,3 but the fact that clinicians providing care to children and adolescents do not have a simple, single BP value to reference creates significant complexity for what should be a relatively straightforward problem. Various approaches to this problem have been proposed, ranging from creation of a simplified table of BP values to automated display of BP percentiles within the electronic health record.4,5 Most recently, in the American Academy of Pediatrics’ (AAP) 2017 “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents,” a simplified table was … Address correspondence to Joseph T. Flynn, MD, MS, FAAP, Division of Nephrology, Seattle Children’s Hospital, Mail Stop: OC.9.820, 4800 Sand Point Way NE, Seattle, WA 98105-0371. E-mail: joseph.flynn{at}seattlechildrens.org