Resident Nemours Children's Hospital Wilmington, Delaware, United States
Background: Pediatric hypertension (HTN) is a public health concern, affecting approximately 3.5% of children in the United States. Early identification is essential as pediatric HTN leads to HTN in adulthood with increased risk of cardiovascular disease and end-organ damage. At least 3 blood pressure (BP) readings on separate visits are required to make the diagnosis of HTN based on American Academy of Pediatric guidelines which can cause diagnostic challenges that lead to gaps in care. Objective: The goal of this study is to better understand the social determinants of health and clinical factors related to pediatric HTN using longitudinal BP data. Design/Methods: This was a retrospective cohort study of 94,478 patients aged 6 to 17 years seen for well-child checks at Nemours Children’s Health clinic sites in DE, MD, NJ, and PA from August 2017 to October 2022. Logistic regression models were used to evaluate the clinical and social factors involved for each different BP group: (1) at least three elevated BP readings, (2) at least three hypertensive BP readings, and (3) presence of a HTN diagnostic code. Results: We found that 3.2% of participants had elevated or hypertensive BP across three separate visits, while only 1.1% carried a pediatric HTN diagnostic code. The multivariable analysis showed significantly increased odds for having elevated BP, hypertensive BP, and a Primary HTN Diagnostic code for participants that had social demographics of male sex, adolescent age, multiple insurance changes, and clinical parameters of being overweight, obese, and of premature birth. For each of the three groups we studied, race, Area Deprivation Index, and Childhood Opportunity Index (COI) did not show a significant association with having a non healthy BP or a HTN diagnosis.
Conclusion(s): Having individual patient level BP readings is a novel way to assess pediatric HTN as previous studies only used ICD codes for pediatric HTN or BP measurements in one visit to compare variables. This information allows children who meet criteria, who do not carry a diagnosis to be studied. This study confirms the underdiagnosis of pediatric HTN and emphasizes the importance of tracking individual BP trends over time to identify children at risk. While clinical factors like BMI and insurance instability play a significant role in elevated BP, neighborhood-level social factors, such as COI, were not found to be strong predictors of HTN. These findings highlight the need for better screening, consistent healthcare access, and targeted interventions to address pediatric HTN.
