INTRODUCTION: Current estimates suggest that high blood pressure is present in 3-5% of children, although the prevalence of hypertension in obese children may be as high as 20%. The American Academy of Pediatrics recommends routine blood pressure (BP) measurement in children over the age of 3. However, it is not known whether this recommendation is being followed or what factors influence blood pressure measurement in pediatric populations.
METHODS: We examined 115,695 pediatric patients ages 3-17 who had an outpatient primary care visit (family practice or pediatrics) between 2007 and 2009 in two large medical groups. Patient characteristics (sex, age, BMI percentile, and race/ethnicity), and clinic department were extracted from electronic medical record data. The predicted probability of BP measurement was estimated using binomial mixed-model logistic regression adjusted for sex, age, BMI percentile, race/ethnicity and clinic department.
RESULTS: Overall, BP was measured at >80% of children’s visits to pediatric and family medicine clinics. The predicted probability of a BP recorded at a primary care visit increased steadily with age (from 81% in 3-5 year olds to 89% in 15-17 year olds, p for trend <.0001). Of the 60% of visits where children had a recorded BMI, children with BMI =95th percentile were slightly less likely to have a BP recorded compared to BMI 85th-<95th, and BMI<85th (91%, 93%, 94%, respectively, p<.0001). There were no differences by sex or race/ethnicity in the adjusted prevalence of documented BP measurement.
CONCLUSION: Preliminary data from the two large medical groups showed that BPs were documented at a large proportion of children’s primary care visits. Younger children were less likely to have blood pressure measurements recorded than adolescents. The relative lower likelihood of blood pressure in obese children warrants further investigation given the higher prevalence of hypertension in these children.