Pediatric Hypertension Specialists’ Perspectives About Adolescent Hypertension Management

Abstract

Background The current specialty-centric hypertension paradigm is unsustainable given the high prevalence of primary hypertension in adolescents. Objective To describe specialists’ perspectives on referral and comanagement for adolescents with hypertension. Methods Cross-sectional mailed survey of a national sample of 397 pediatric cardiologists and 389 pediatric nephrologists, conducted January to May 2014. Results Response rate was 61%. Both specialties agreed that primary care providers can make the hypertension diagnosis, try lifestyle changes, and comanage monitoring of patient blood pressure control and medication side effects, but they felt antihypertensive medication use should mainly occur in the specialty setting. Conclusions Our study suggests specialist support for changing the hypertension paradigm to encourage primary care providers, in collaboration with specialists, to diagnose hypertension, initiate lifestyle changes, and monitor progress and side effects. Future work should focus on supporting primary care physician comanagement of adolescents with hypertension.

Pediatric Hypertension: Provider Perspectives

“… 13 In prior research exploring pediatric subspecialists’ perspectives on the diagnosis and management of hypertension, subspecialists endorsed that medication and other hypertension management should occur in subspecialty settings. 14 This same study highlighted the additional work needed to coordinate co-management of patients between primary and subspecialty care.…”

The Impact of Early Recognition and Treatment of Systemic Hypertension on Reducing Blood Pressure: The Hypertension and Vascular Evaluation Program

“…19 The multidisciplinary approach is expected to reduce the variation in HTN care more effectively than attending individual specialty visits alone. 20 CHOP has a catchment area that serves 41% of children and adolescents with cardiovascular risk factors such as obesity, diabetes, hyperlipidemia, and a sedentary lifestyle. 21 The clinic structure has been previously described elsewhere.…”

Pediatric Hypertension: Parent Perspectives

“…Parents, even those whose children have received a diagnosis, may be confused about the diagnosis simply because clinicians are confused about the diagnosis. 5 , 14 , 18 , 19 Medical providers need to engage parents and children in the diagnostic process better. For example, parents could be informed that BP values can vary a lot, which is why an average across 3 appointments is needed.…”