Comparative Effectiveness Research through Collaborative Electronic Reporting Consortium Research Team, Elk Grove Village, Illinois;
Center for Clinical Informatics Research and Education and.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2019-3778. Epub 2020 Sep 18.
To determine the natural history of pediatric hypertension.
We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared.
Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months.
In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.
确定儿科高血压的自然病程。
我们对 165 个初级保健站点进行了为期 72 个月的回顾性队列研究。比较了连续两个 36 个月的血压测量值。
在 3 至 18 岁的 398079 名初级保健儿科患者中，有 89347 人在 36 个月期间记录了≥3 次血压水平，有 43825 名儿童在连续两个 36 个月期间记录了≥3 次血压水平。在这 43825 名儿童中，有 4.3%（1881 人）符合高血压标准（3.5%[1515 人]1 期，0.8%[366 人]2 期），有 4.9%（2144 人）在最初的 36 个月中符合血压升高标准。在第二个 36 个月期间，50%（933 人）的高血压患者血压水平正常，22%（406 人）血压升高或<3 次高血压血压水平，29%（542 人）有≥3 次高血压血压水平。在最初的 36 个月中血压升高的 2144 名患者中，70%（1492 人）血压水平正常，18%（378 人）持续性血压升高，13%（274 人）在第二个 36 个月中发展为高血压。在最初的 36 个月中血压异常的 7775 名患者中，只有 52%（4025 人）在第二个 36 个月中有≥3 次血压记录。
在初级保健队列中，最初符合高血压或血压升高标准的大多数儿童随后血压水平正常或未接受建议的随访测量。这些结果突出表明，需要更细致的初始血压评估和系统来促进异常结果的随访。
