Recognition Of Elevated Blood Pressure Research Articles

Review on concepts of hypertension treatment

The outcome of treatment in elderly hypertensives is examined in six major randomized controlled trials. Thiazide diuretics were first-or second-line drugs in each, and the development of a national database on normative blood pressure levels throughout childhood has contributed to the recognition of elevated blood pressure in children and adolescents. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early.

Screening for hypertension using emergency department blood pressure measurements can identify patients with undiagnosed hypertension: A systematic review with meta-analysis.

Hypertension is the leading risk factor for death globally. A significant percentage of patients admitted to hospital have undiagnosed hypertension, yet recognition of elevated blood pressure (BP) in hospital and referral for post‐discharge assessment are poor. Physician perception that elevated inhospital BP is attributable to anxiety, pain, or white coat syndrome may underlie an expectation that BP will normalize following discharge. However, these patients frequently remain hypertensive. The authors conducted a systematic review to evaluate the extent to which elevated inhospital BP can predict the presence of hypertension in previously undiagnosed adults. The authors included cohort studies in which hospital patients whose BP exceeded the study threshold underwent further post‐discharge BP assessment following discharge. Twelve studies were identified as eligible for inclusion; a total of 2627 participants met review eligibility criteria, and follow‐up BP data were available for 1240 (47.2%). Median percentage of patients remaining hypertensive following discharge was 43.6% (range: 14.2‐76.5). Across 7 studies which identified people with possible hypertension using an index test threshold of 140/90, the pooled proportion subsequently identified with hypertension at follow‐up was 43.4% (95% CI: 25.1%‐61.8%). This review indicates that screening for hypertension in the emergency hospital environment consistently identifies groups of patients with undiagnosed hypertension. Unscheduled hospital attendance therefore offers an important public health opportunity to identify patients with undiagnosed hypertension.

Improving recognition of elevated blood pressure in pediatric primary care patients

Background: Elevated blood pressure (BP) is increasingly prevalent in the pediatric population, and has important long term health risks. Yet studies show that pediatricians often fail to recognize elevated BP. Local Problem and Aims: To improve recognition and management of elevated BPs among patients age 3 and older attending well child care visits at two pediatric primary care practices we aimed to (1) improve provider knowledge regarding the diagnosis and management of hypertension and (2) increase the percentage of patients with BP ≥90% with a repeat blood pressure documented to 70% over a 2 year …

Improving recognition of elevated blood pressure in pediatric primary care patients

Improving recognition of elevated blood pressure in pediatric primary care patients

Improving Recognition of Abnormal Blood Pressure and Implementing Appropriate Management in the Pediatric Outpatient Clinic

Background: Hypertension and pre-hypertension in childhood are underdiagnosed, likely because of decreased recognition of elevated blood pressure (BP). Poor recognition has been shown to be most influenced by the absence of obviously elevated BP, obesity, and a family history of cardiovascular disease. Inaccuracies in pediatric outpatient blood pressure measurement were also noted based on caregivers’ level of expertise in pediatric hypertension. In the Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents by the National Institute of Health (NIH), definitions and management for pre-hypertension, stage 1 hypertension, …

Cardiovascular risk factor screening and management of obese patients at an outpatient pediatric cardiology center.

ObjectiveTo evaluate documentation of cardiovascular (CV) risk factors and obesity management by pediatric cardiologists.Study designReview of medical records of obese (≥95th body mass index percentile) 2–17 year-old children presenting to outpatient pediatric cardiology over 1 year. Subjects were categorized as: heart disease (HD) with increased risk for atherosclerosis; HD with average risk for atherosclerosis; or no HD. Data were evaluated on documentation of the assessment of seven CV risk factors [including recognition of elevated blood pressure (BP)] and management of obesity. Multivariable logistic regression (LR) examined physician documentation of obesity intervention by risk groups, including age and gender.ResultsData on 730 subjects were analyzed; 16 % had HD with increased risk for atherosclerosis, 41 % had HD with average risk for atherosclerosis, and 43 % had no HD. Documentation of risk factor assessment was highest for physical inactivity (53 %) and recognition of obesity (47 %). Other factors (child dyslipidemia, diet, dysglycemia, and cigarette exposure) were documented less frequently. Elevated BP was found in 144 patients (20 %); 53/144 (37 %) had documentation of elevated BP recognition. An obesity intervention was documented in 62 % of records and did not significantly differ between risk groups. In the multivariate LR, physician documentation of obesity intervention did not significantly differ between risk groups.ConclusionsComplete assessment of CV risk factors in obese patients is low. The number of risk factors assessed was similar among patients with HD with average risk of atherosclerosis and HD with increased risk of atherosclerosis. Increased care coordination between cardiologists and primary care providers may lead to uniform, comprehensive CV risk assessment.

Recognition and Management of Elevated Blood Pressure in Pediatric Patients: Challenges and Disparities in Community Health Centers

The prevalence of childhood elevated blood pressure (EBP)-a single blood pressure recording above the normal range-is increasing in the United States. Recognizing childhood EBP is difficult because classification is a function of age, sex, and height. We assessed the frequency of clinical recognition of EBP and follow-up care in a sample of pediatric patients seen in 2010 and followed up through September 2013 in a network of 8 urban health centers. Of 754 patients with BP measurements, 261 (35 %) had at least 1 EBP reading during the study period. Of those with an EBP reading, 52 (20 %) had at least 1 EBP reading noted in their medical record. Clinicians were more likely to recognize EBP in overweight/obese [OR 3.27 (95 % confidence interval (CI) 1.64-6.51)] and male [OR 2.83 (95 % CI 1.64-4.42)] children. Strategies to support routine monitoring of BP status could improve identification and management of pediatric EBP.

Recognition of Elevated Blood Pressure in an Outpatient Pediatric Tertiary Care Setting

To assess the prevalence of elevated blood pressure (BP) and its identification among outpatients at a pediatric tertiary care hospital and to assess clinician attitudes towards BP management. A retrospective review was undertaken of electronic medical record data of visits over the course of 1 year to 10 subspecialty divisions and 3 primary care services at an urban tertiary care hospital. Interviews of division/service representatives and a clinician survey on perceived role on BP care, practices, and protocols related to BP management were conducted. Elevated BP was defined as ≥90th percentile (using US references); identification of elevated BP was defined as the presence of appropriate codes in the problem list or visit diagnoses. Among 29,000 patients (ages 2-17 years), 70% (those with ≥1 BP measurement) were analyzed. Patients were as follows: 50% male; 42% white, 31% Hispanic, 16% black, 5% Asian, and 5% other/missing; 52% had Medicaid insurance. A total of 64% had normal BPs, 33% had 1-2 elevated BP measurements, and 3% had ≥3 elevated BP measurements. Among those with ≥3 elevated BP measurements, the median frequency of identification by division/service was 17%; the greatest identification was for Kidney Diseases (67%), Wellness & Weight Management (60%), and Cardiology (33%). Among patients with ≥3 elevated BP measurements, 21% were identified vs 7% identified among those with 1-2 increased measurements (P<.001). All clinician survey respondents perceived self-responsibility for identification of elevated BP, but opinions varied for their role in the management of elevated BP. The identification of patients with elevated BP measurements was low. Strategies to increase the identification of elevated BPs in outpatient tertiary care settings are needed.

Pediatric Hypertension: Recent Trends and Accomplishments, Future Challenges

Publication of the Fourth Report on high blood pressure (BP) in children and adolescents by the National High BP Education Program (NHBPEP) in 2004 has been followed by a remarkable increase in interest in pediatric hypertension. New data have emerged on the epidemiology of hypertension in the young, the influence of the childhood obesity epidemic on BP, how ambulatory BP monitoring (ABPM) can be used in evaluating elevated BP and the extent of hypertensive target-organ damage in the pediatric age group. Exciting new information on drug treatment of pediatric hypertension has been produced by industry-sponsored clinical trials of antihypertensive medications spurred by the FDA Modernization Act (FDAMA) and successor legislation. Despite these trends, recognition of elevated BP in children and adolescents by primary care providers remains problematic. This article will highlight these and other aspects of pediatric hypertension, hopefully providing a snapshot of where we are in early 2008, and pointing out areas where further work is needed in order to reduce the future burden of adult cardiovascular disease.

Current perspectives on preeclampsia

The early recognition of elevated blood pressure in pregnancy is still considered the most critical step in preventing the maternal and perinatal morbidity and mortality associated with preeclampsia-eclampsia. The recognition of hypertension is enhanced by an initial assessment of a woman's risk for developing high blood pressure during pregnancy, correct blood pressure measurement, and early prenatal care. The care of the woman with hypertension preceding a pregnancy or during a previous pregnancy includes not only early prenatal care but also pre- or interconceptual care that might minimize the risk of further blood pressure elevation during pregnancy, as well as later in life. Tests to predict preeclampsia, such as the “roll” test and the use of the mean arterial pressure during midpregnancy, have been found to be invalid because of poor predictive validity. Relative increases in blood pressure during pregnancy are also no longer considered diagnostic for preeclampsia, however, consideration of relative increases is still “prudent” in assessing signs and symptoms of this disease. The development of preeclampsia is thought to occur very early in pregnancy as a result of imbalances between vasoconstrictive and vasodilatory factors, probably accompanying implantation and placentation. The use of aspirin to prevent the development of hypertension and preeclampsia is currently being studied because it has been shown to shift the balance toward the metabolism of the vasodilatory prostaglandin, prostacycline. At this time, aspirin is only advised for women at high risk for developing preeclampsia. Calcium may also be a preventative mineral, and a diet that is adequate during pregnancy is advised.