Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Despite tests, high blood pressure hard to recognize in children

03.05.2010
Complex guidelines for age, height, gender hamper recognition

A Johns Hopkins Children's Center study of 2,500 patient records suggests that medical staff fails to check a child's blood pressure a fifth of the time, and is not recognizing what constitutes an abnormal reading in those whose blood pressure they do check.

Researchers at Hopkins Children's say the consequences are that pediatricians and nurses may be missing the development of hypertension and its serious consequences, even when they do take blood pressure measurements.

The American Academy of Pediatrics' (AAP) guidelines call for regular blood pressure checks in children 3 years and older to screen for elevated blood pressure, and say elevated blood pressure on three consecutive medical visits qualifies as hypertension. Even a single episode of high blood pressure can indicate hypertension and should trigger repeat measurements during the visit and subsequent doctor visits, the AAP says.

The problem is that measuring a child's blood pressure is far more complicated than it is in adults and requires interpreting each individual measure against a reference table for age, gender and height, says lead investigator Tammy Brady, M.D., M.H.S., a nephrologist at Hopkins Children's.

The researchers analyzed 2,500 records of visits to the pediatrician's office. Medical staff did not check blood pressure in 500 of the cases. Elevated blood pressure scores were recorded in 726 cases of the 2,000 measurements taken, but the implications went unrecognized and unremarked upon in 87 percent of them, the study found.

The findings, to be published in June's Pediatrics and appearing online May 3, underscore the need for better recognition and aggressive monitoring of all children to prevent both the short-term and long-term complications of hypertension, the investigators say.

The study found that medical staff was more likely to miss elevated blood pressures in children of normal weight and in those without a family history of cardiovascular disease. The same was true for those children whose blood pressure was at or below 120/80, a score considered ideal in adults, but one that may portend trouble in a child, depending on height, gender and age.

Blood pressure parameters in adults are clearly defined, but the complicated arithmetic involved in children's blood pressure may be one of the greatest barriers to recognizing a child's elevated pressure, the investigators say.

Brady says more education and automated systems that alert the medical staff if a child's blood pressure is out of range can help. Hopkins Children's is currently testing one such alert system and will soon publish data on its effectiveness.

Hypertension, defined as persistently elevated blood pressure, can cause kidney, eye and heart damage, but while some complications take years and decades to develop, certain ones evolve quickly, the researchers say. A dangerous thickening of the heart muscle called left-ventricular hypertrophy can develop in a matter of months in children with untreated hypertension, but is reversible with early treatment.

Because high blood pressure rarely causes symptoms, medical staff may overlook a child who has no traditional risk factors, such as obesity or family history, the researchers say. Half of the children in the study with elevated blood pressure were normal weight.

"Nurses and doctors may be so falsely reassured by a child's lack of symptoms and risk factors that they either miss milder elevations or may chalk them up to measurement error and never follow up on them," Brady says.

In the study, covering children ages 3 to 20 visiting a primary care pediatric clinic at Johns Hopkins, high blood pressure was discovered in six percent of healthy-weight children and in 20 percent of overweight and obese children. Even though medical staff was more attentive to elevated blood pressure among overweight and obese children, high blood pressure was still missed in four out five of them. Children with scores below 120/80 were nearly eight times more likely to have their high blood pressure missed than children with blood pressure above 120/80. Children without a family history of cardiovascular disease were twice as likely to have their high blood pressure unrecognized as those with family history.

The research was funded by the American Kidney Fund, the National Kidney Foundation and the National Institutes of Health.

Co-investigators include Barry Solomon, M.D., M.P.H., Alicia Neu, M.D., George Siberry, M.D., M.P.H., and Rulan Parekh, M.D., M.S., of the Hospital for Sick Children, Toronto.

Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. Hopkins Children's is consistently ranked among the top children's hospitals in the nation. Hopkins Children's is Maryland's largest children's hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in 20 pediatric subspecialties, including allergy, cardiology, transplant, neurology, neurosurgery, cystic fibrosis, pulmonary, nephrology, gastroenterology and oncology.

Ekaterina Pesheva | EurekAlert!
Further information:
http://www.jhmi.edu
http://www.hopkinschildrens.org

More articles from Health and Medicine:

nachricht Biofilm discovery suggests new way to prevent dangerous infections
23.05.2017 | University of Texas at Austin

nachricht Another reason to exercise: Burning bone fat -- a key to better bone health
19.05.2017 | University of North Carolina Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Turmoil in sluggish electrons’ existence

An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.

We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...

Im Focus: Wafer-thin Magnetic Materials Developed for Future Quantum Technologies

Two-dimensional magnetic structures are regarded as a promising material for new types of data storage, since the magnetic properties of individual molecular building blocks can be investigated and modified. For the first time, researchers have now produced a wafer-thin ferrimagnet, in which molecules with different magnetic centers arrange themselves on a gold surface to form a checkerboard pattern. Scientists at the Swiss Nanoscience Institute at the University of Basel and the Paul Scherrer Institute published their findings in the journal Nature Communications.

Ferrimagnets are composed of two centers which are magnetized at different strengths and point in opposing directions. Two-dimensional, quasi-flat ferrimagnets...

Im Focus: World's thinnest hologram paves path to new 3-D world

Nano-hologram paves way for integration of 3-D holography into everyday electronics

An Australian-Chinese research team has created the world's thinnest hologram, paving the way towards the integration of 3D holography into everyday...

Im Focus: Using graphene to create quantum bits

In the race to produce a quantum computer, a number of projects are seeking a way to create quantum bits -- or qubits -- that are stable, meaning they are not much affected by changes in their environment. This normally needs highly nonlinear non-dissipative elements capable of functioning at very low temperatures.

In pursuit of this goal, researchers at EPFL's Laboratory of Photonics and Quantum Measurements LPQM (STI/SB), have investigated a nonlinear graphene-based...

Im Focus: Bacteria harness the lotus effect to protect themselves

Biofilms: Researchers find the causes of water-repelling properties

Dental plaque and the viscous brown slime in drainpipes are two familiar examples of bacterial biofilms. Removing such bacterial depositions from surfaces is...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

AWK Aachen Machine Tool Colloquium 2017: Internet of Production for Agile Enterprises

23.05.2017 | Event News

Dortmund MST Conference presents Individualized Healthcare Solutions with micro and nanotechnology

22.05.2017 | Event News

Innovation 4.0: Shaping a humane fourth industrial revolution

17.05.2017 | Event News

 
Latest News

Scientists propose synestia, a new type of planetary object

23.05.2017 | Physics and Astronomy

Zap! Graphene is bad news for bacteria

23.05.2017 | Life Sciences

Medical gamma-ray camera is now palm-sized

23.05.2017 | Medical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>