TY - JOUR
T1 - Evaluation of pediatric patients with mild-to-moderate hypertension
T2 - Yield of diagnostic testing
AU - Wiesen, Jonathan
AU - Adkins, Matthew
AU - Fortune, Sherwin
AU - Horowitz, Judah
AU - Pincus, Nava
AU - Frank, Rachel
AU - Vento, Suzanne
AU - Hoffman, Cathy
AU - Goilav, Beatrice
AU - Trachtman, Howard
PY - 2008/11
Y1 - 2008/11
N2 - Objective. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. Methods. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mm Hg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. Results. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13. 3 ± 4. 4 years. BMI was 26. 1 ± 6. 7 kg/m 2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. Conclusions. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.
AB - Objective. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. Methods. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mm Hg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. Results. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13. 3 ± 4. 4 years. BMI was 26. 1 ± 6. 7 kg/m 2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. Conclusions. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.
KW - Ambulatory blood pressure monitoring
KW - Echocardiogram
KW - Essential hypertension
KW - Lipid profile
KW - Metabolic syndrome
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U2 - 10.1542/peds.2008-0365
DO - 10.1542/peds.2008-0365
M3 - Article
C2 - 18977966
AN - SCOPUS:58149162859
SN - 0031-4005
VL - 122
SP - e988-e993
JO - Pediatrics
JF - Pediatrics
IS - 5
ER -