Dr Tammy Brady Describes Efforts to Improve Diagnosis of Hypertension in Children

Better blood pressure measurement techniques, electronic health record alerts, and simpler clinical practice guidelines can all help primary care clinicians identify hypertension in children, said Tammy Brady, MD, PhD, medical director of the Pediatric Hypertension Program and associate professor of pediatrics at Johns Hopkins University.

How can the diagnosis of hypertension in children be improved?
This is a particular interest of mine, something that I’ve worked on throughout my career. And there’s been several things that I’ve found that have actually worked. Increasing provider awareness of the prevalence of hypertension and the downstream effects of hypertension in childhood has been helpful. Educating providers on the proper blood pressure measurement techniques, and how each step, when they’re not implemented properly, how that impacts blood pressure and leads to erroneous blood pressure measurement—that has been unbelievably impactful. And as providers and practices start to implement the proper blood pressure measurement technique in their practices, they find that they have more confidence in the blood pressures that they get, they’re less likely to brush them off and say, perhaps it was measurement error or what have you. And in fact, when you have proper blood pressure measurement technique, you have less false positives, and so there’s less need to intervene and repeat. So, it really has led to some good success in improving the recognition of elevated blood pressure in a primary care setting.

Additionally, electronic medical record alerts can actually be pretty impactful and increase awareness to elevations, particularly as kids, or as elevated blood pressure in children varies based on your age, your sex, and your height up until age 12. That can be challenging in a pediatric practice, so having an electronic alert can be helpful.

And then participating in quality improvement projects as well as quality improvement collaboratives has been very impactful in increasing provider awareness, and so I think there’s a lot of hope down the line in that regard.

I think the other thing is that the new clinical practice guidelines made it simpler for pediatricians to identify elevated blood pressure. So the age, sex, and height based blood pressure thresholds really only apply up until 12 years of age, and then from 13 years of age and up, we have more strict cutoffs that correspond to the ones in adults, so it’s a lot easier to recognize an elevated blood pressure in that regard. And the clinical practice guidelines provide tools for pediatricians to use in a clinic setting to make it easier as well.
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