Study examines use of diagnostic tests in adolescents with hypertension

July 23, 2012

A study of adolescents with hypertension enrolled in the Michigan Medicaid program suggests that guideline-recommended diagnostic tests – echocardiograms and renal ultrasonography – were poorly used, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine.

is a growing problem for adolescents because of the association between obesity and hypertension. Current pediatric guidelines recommend laboratory tests and renal ultrasonography for all pediatric patients with hypertension to rule out renal (kidney) disease. The guidelines also recommend echocardiograms to assess target organ damage. But little is known about echocardiogram use among adolescents in comparison with other recommended diagnostic tests (renal ultrasonography) and nonrecommended, but more readily available tests, such as electrocardiograms (EKGs), according to the study background.

Esther Y. Yoon, M.D., M.P.H., and colleagues of the University of Michigan, Ann Arbor, examined echocardiogram use in adolescents and compared it with EKG and renal ultrasonography use in an analysis of administrative claims data from the Michigan from 2003 to 2008.

There were 951 adolescents with "essential" hypertension (i.e., the cause is unknown) who had antihypertensive pharmacy claims: 24 percent (226) had echocardiograms; 22 percent (207) had renal ultrasonography; and 50 percent (478) had EKGs, the results indicate.

"Our study describes for the first time, to our knowledge, equally low levels of obtaining echocardiograms and renal ultrasonography, which are recommended by national hypertension guidelines, by adolescents with essential hypertension," the authors note. "In contrast, we found that one-half of adolescents with essential hypertension had at least one EKG during the study period, a diagnostic test that is not recommended by pediatric hypertension guidelines but one that is recommended for adults with hypertension."

Boys, younger adolescents, those who had EKGs and those who had renal ultrasonography were more likely to receive echocardiograms compared with girls, older adolescents, and those who did not have EKGs or renal ultrasonography.

The authors suggest that the patterns of EKG and echocardiogram use in their study raises questions "about the level of familiarity, awareness or agreement with pediatric hypertension guideline recommendations and the rationale behind these recommendations."

"The decision and choice of to evaluate for target organ damage in with essential hypertension warrant further study to understand the underlying rationale for those decisions and to determine treatment effectiveness," the researchers conclude.

In an editorial, Sarah D. de Ferranti, M.D., M.P.H., of Boston Children's Hospital, and Matthew W. Gillman, M.D., S.M., of Harvard Medical School, Boston, write: "The answers to the many questions raised here are unclear, pointing to the need for more information about the extent to which the BP [blood pressure] guidelines overall, and recommended diagnostic testing in particular, are implemented."

"It is important to get these answers," they continue.

"Future revision of the will require not only updating the evidence base for what should be done in ideal circumstances, but also what can be done in the real world given the range of possible health care provider, patient and payor facilitators and barriers to implementation," they conclude.

Explore further: Study tests new therapy for treatment-resistant hypertension

More information:
Arch Pediatr Adolesc Med. Published online July 23, 2012. doi:10.1001/archpediatrics.2012.1173
Arch Pediatr Adolesc Med. Published online July 23, 2012. doi:10.1001/archpediatrics.2012.1503

Related Stories

Study tests new therapy for treatment-resistant hypertension

June 28, 2012
(Medical Xpress) -- Treatment-resistant hypertension affects nearly 6 million Americans and another 94 million people worldwide and is associated with increased cardiovascular risk, including stroke and heart attack, as well ...

Study examines use of waist measures among overweight and obese adolescents

April 2, 2012
Waist measures (waist circumference, waist to height ratio) in conjunction with body mass index appear to be associated with lipid and blood pressure assessments among overweight and obese adolescents, according to a report ...

New study challenges current thinking on risk factors for contrast induced nephrotoxicity

May 1, 2012
Contrary to current belief, a new study finds that patients with a history of diabetes are not one of the most at risk for contrast induced nephrotoxicity. Instead, the study found that patients with a history of renal disease, ...

Recommended for you

Injuries from window blinds send two children to the emergency department every day

December 11, 2017
Most homes have them. They help keep our rooms warm or cold and even add a pop of color to tie the décor together. But window blinds can cause serious injuries or even death to young children. A new study from the Center ...

Blood flow altered in brains of preterm newborns vs. full-term infants

December 4, 2017
Cerebral blood flow (CBF) of key regions of newborns' brains is altered in very premature infants and may provide an early warning sign of disturbed brain maturation well before such injury is visible on conventional imaging, ...

HPV vaccine is effective, safe 10 years after it's given

November 29, 2017
A decade of data on hundreds of boys and girls who received the HPV vaccine indicates the vaccine is safe and effective long term in protecting against the most virulent strains of the virus, researchers report.

Antibiotics administered during labor delay healthy gut bacteria in babies

November 28, 2017
Antibiotics administered during labour for Group B Streptococcus (GBS) affect the development of gut bacteria in babies, according to a study from McMaster University.

Stress in pregnancy linked to changes in infant's nervous system, less smiling, less resilience

November 23, 2017
Maternal stress during the second trimester of pregnancy may influence the nervous system of the developing child, both before and after birth, and may have subtle effects on temperament, resulting in less smiling and engagement, ...

Molecules in spit may be able to diagnose and predict length of concussions

November 20, 2017
Diagnosing a concussion can sometimes be a guessing game, but clues taken from small molecules in saliva may be able to help diagnose and predict the duration of concussions in children, according to Penn State College of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.