Pediatric Hypertension: Parent Perspectives

Abstract

Clinical practice guidelines for diagnosis and management of pediatric hypertension have been available for decades. Yet, most cases of hypertension in children are undiagnosed. Provider and system-based factors, such as the complexity of diagnostic standards, and a failure among physicians to recognize the importance of hypertension in children, play a role in underdiagnosis. It is unclear, however, how patient and family behaviors impact the diagnosis and treatment of pediatric hypertension. We aimed to explore the perspectives of parents whose children have had multiple high blood pressure readings or have been diagnosed with hypertension to inform clinicians with areas for practice improvement. In a 2 site qualitative study, we interviewed parents of 15 children diagnosed with hypertension. Results from semi-structured interviews with parents revealed barriers to the diagnosis of pediatric hypertension, including uncertainty about the diagnosis and concerns around the accuracy of blood pressure measurements. Delay in diagnosis and lack of child engagement emerged as obstacles to the treatment of pediatric hypertension.

Role of cardio-ankle vascular index as a predictor of left ventricular hypertrophy in the evaluation of pediatric hypertension

“…Hypertension (HTN) in the pediatric population has long been recognized as a diagnostic challenge to clinicians [1][2][3]. Further, despite recent successful efforts to simplify/optimize screening and management guidelines [4,5], consistent and effective management of HTN in this age group remains challenging. While this is due in part to the complex diagnostic standard for pediatric HTN [average systolic and/or diastolic blood pressure (BP) that is ≥ 95th percentile for gender, age, and height on three or more separate occasions [4]], another shortcoming on the part of medical providers is failure to educate on the implications of the diagnosis once it has been made [5,6].…”

“…Further, despite recent successful efforts to simplify/optimize screening and management guidelines [4,5], consistent and effective management of HTN in this age group remains challenging. While this is due in part to the complex diagnostic standard for pediatric HTN [average systolic and/or diastolic blood pressure (BP) that is ≥ 95th percentile for gender, age, and height on three or more separate occasions [4]], another shortcoming on the part of medical providers is failure to educate on the implications of the diagnosis once it has been made [5,6]. This becomes understandable when one considers that despite the known association between pediatric HTN and end organ damage [left ventricular hypertrophy (LVH), chronic kidney injury, etc.]…”

A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation

“…These included lack of systematic approach to measuring (e.g., children not sitting still; lack of proper equipment; not using manual BP readings) and reviewing BP values, difficulty interpreting BP readings and coordinating reassessment and necessary clinical actions within the workflow, and difficulty scheduling and completing follow-up appointments [ 22 ]. Parents of children with pHTN have also expressed uncertainty about diagnostic accuracy and treatment indication [ 23 ].…”