Abstract
BACKGROUND/AIMS: Current estimates suggest that high blood pressure is present in 3–5% of children, although the prevalence of hypertension in obese children may be as high as 20%. The American Academy of Pediatrics recommends routine blood pressure measurement in children over the age of 3. However, it is not known whether this recommendation is being followed or what factors influence blood pressure measurement in pediatric populations. METHODS: We examined 115,695 pediatric patients ages 3–17 who had an outpatient primary care visit (family practice or pediatrics) between 2007 and 2009 in two large medical groups in Minnesota and Colorado. Patient characteristics (sex, age, BMI percentile, and race/ethnicity), and clinic department were extracted from electronic medical record data. The predicted probability of blood pressure measurement was estimated using binomial mixed-model logistic regression with maximum likelihood estimation adjusted for sex, age, BMI percentile, race/ethnicity and clinic department. RESULTS: Overall, blood pressure was measured at >80% of children’s visits to pediatric and family medicine clinics. The predicted probability of a blood pressure recorded at a primary care visit increased steadily with age (from .81 in 3–5 year olds to .89 in 15–17 year olds, p for trend <.0001). Of the 60% of visits where children had a recorded BMI, children with a BMI =95th percentile were slightly less likely to have a blood pressure recorded compared to BMI 85th <95th, and BMI<85th (91%, 93%, 94%, respectively, p<.0001). There were no differences by sex or race/ethnicity in the adjusted prevalence of documented blood pressure measurement. CONCLUSIONS: Blood pressure measurements are documented at a large proportion of children’s visits to pediatric and family medicine clinics. Younger children were less likely to have blood pressure measurements recorded than adolescents. The relative lower likelihood of blood pressure measurement in obese children warrants further investigation given the higher prevalence of hypertension in these children.