Medical management of children with primary hypertension by pediatric subspecialists

Esther Y. Yoon*, Matthew M. Davis, Albert Rocchini, David Kershaw, Gary L. Freed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Our aim was to characterize medical management of children with primary hypertension (HTN) by pediatric subspecialists. We performed a medical-record review of children ≤18 years with primary HTN seen at pediatric cardiology or pediatric nephrology clinics at an academic center. Main outcomes were whether treatment decision was in agreement with national guidelines, whether an antihypertensive medication was prescribed, and medication choice. One hundred and eighty children had ≥1 visit to a pediatric cardiology or nephrology clinic. The majority (83%) of children were pharmacologically managed according to national guidelines. However, only 1/3 children with stage 2 HTN received appropriate antihypertensive therapy from either subspecialty. Only 26 children were prescribed an antihypertensive drug. Children evaluated by pediatric nephrologists were fourfold more likely to receive an antihypertensive than children seen by pediatric cardiologists (29% vs. 7%; p<0.001). However, all antihypertensive prescriptions were prescribed according to guidelines by both subspecialties. Medical management of children with primary HTN by pediatric cardiologists and pediatric nephrologists is largely consistent with guidelines. However, initiation of appropriate antihypertensive drugs for children with highest severity of HTN is equally poor for both subspecialties. Future studies should explore the factors underlying physicians' reluctance to initiate recommended chronic pharmacologic therapy in children and its associated outcomes.

Original languageEnglish (US)
Pages (from-to)147-153
Number of pages7
JournalPediatric Nephrology
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2009

Keywords

  • Children
  • Guidelines
  • Hypertension
  • Prescribing
  • Subspecialty

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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