Under-recognition of pediatric hypertension diagnosis: Examination of 1 year of visits to community health centers

Anoosh Moin*, Nivedita Mohanty, Yacob G. Tedla, Allison J. Carroll, Roxane Padilla, Craig B. Langman, Justin D. Smith

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Pediatric hypertension is associated with significant target organ damage in children and cardiovascular morbidity in adulthood. Appropriate diagnosis and management per guideline recommendations are inconsistent. In this study, we determined the proportion of missed diagnosis of hypertension and prehypertension and appropriate follow-up in pediatric patients, stratified by sex, age, race/ethnicity, and weight status. Based on the electronic health record (EHR) data from eight federally qualified health centers, among 62,982 children aged 3 to 18 years, 6233 (10%) had at least one abnormal blood pressure (BP) measurement over twelve months. Among those children whose recorded BPs met the criteria for prehypertension (N = 6178), 14.6% had a diagnosis in the EHR. These children were more likely to be White and have obesity compared with children who met the criteria but were not diagnosed with prehypertension. Among those who met the criteria for hypertension (N = 55), 41.8% had a diagnosis of hypertension in the EHR. Being diagnosed with hypertension was not associated with any examined patient characteristics. Over eleven months, 2837 children had BP ≥ 95th percentile on ≥ 1 visit. Only 13% had guideline-adherent follow-up within 1 month and were more likely to be older, female, and of Hispanic ethnicity or “other” race. Over six months, 2902 children had BP ≥ 90th percentile on one visit. 41% had guideline-adherent follow-up within 6 months and were more likely to be older, of either White, Hispanic, Asian race, or Hispanic ethnicity. In a community-based setting, pediatric hypertension and prehypertension were persistently underdiagnosed with low adherence to recommended follow-up.

Original languageEnglish (US)
Pages (from-to)257-264
Number of pages8
JournalJournal of Clinical Hypertension
Issue number2
StatePublished - Feb 2021


  • Childhood
  • community
  • diagnosis
  • elevated blood pressure
  • follow-up
  • hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine


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