Evaluation of pediatric patients with mild-to-moderate hypertension

Yield of diagnostic testing

Jonathan Wiesen, Matthew Adkins, Sherwin Fortune, Judah Horowitz, Nava Pincus, Rachel Frank, Suzanne Vento, Cathy Hoffman, Beatrice Goilav, Howard Trachtman

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. Methods. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mm Hg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. Results. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13. 3 ± 4. 4 years. BMI was 26. 1 ± 6. 7 kg/m 2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. Conclusions. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.

Original languageEnglish (US)
JournalPediatrics
Volume122
Issue number5
DOIs
StatePublished - Nov 2008

Fingerprint

Ambulatory Blood Pressure Monitoring
Pediatrics
Hypertension
Urinalysis
Kidney
Lipids
Reading
Fasting
Cholesterol
Blood Pressure
Nutrition Assessment
Hypercholesterolemia
Serum
Physical Examination
Echocardiography
Ultrasonography
History
Population

Keywords

  • Ambulatory blood pressure monitoring
  • Echocardiogram
  • Essential hypertension
  • Lipid profile
  • Metabolic syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Wiesen, J., Adkins, M., Fortune, S., Horowitz, J., Pincus, N., Frank, R., ... Trachtman, H. (2008). Evaluation of pediatric patients with mild-to-moderate hypertension: Yield of diagnostic testing. Pediatrics, 122(5). https://doi.org/10.1542/peds.2008-0365

Evaluation of pediatric patients with mild-to-moderate hypertension : Yield of diagnostic testing. / Wiesen, Jonathan; Adkins, Matthew; Fortune, Sherwin; Horowitz, Judah; Pincus, Nava; Frank, Rachel; Vento, Suzanne; Hoffman, Cathy; Goilav, Beatrice; Trachtman, Howard.

In: Pediatrics, Vol. 122, No. 5, 11.2008.

Research output: Contribution to journalArticle

Wiesen, J, Adkins, M, Fortune, S, Horowitz, J, Pincus, N, Frank, R, Vento, S, Hoffman, C, Goilav, B & Trachtman, H 2008, 'Evaluation of pediatric patients with mild-to-moderate hypertension: Yield of diagnostic testing', Pediatrics, vol. 122, no. 5. https://doi.org/10.1542/peds.2008-0365
Wiesen, Jonathan ; Adkins, Matthew ; Fortune, Sherwin ; Horowitz, Judah ; Pincus, Nava ; Frank, Rachel ; Vento, Suzanne ; Hoffman, Cathy ; Goilav, Beatrice ; Trachtman, Howard. / Evaluation of pediatric patients with mild-to-moderate hypertension : Yield of diagnostic testing. In: Pediatrics. 2008 ; Vol. 122, No. 5.
@article{c5f0254b4fa944e19343606cca504064,
title = "Evaluation of pediatric patients with mild-to-moderate hypertension: Yield of diagnostic testing",
abstract = "Objective. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. Methods. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95{\%} + 20/10 mm Hg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. Results. A total of 249 patients were identified, and charts for 220 (88{\%}) were available for review. There were 156 boys and 64 girls aged 13. 3 ± 4. 4 years. BMI was 26. 1 ± 6. 7 kg/m 2, and 143 (65{\%}) had a BMI of ≥90{\%}. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42{\%}) had total cholesterol values of >170 mg/dL, and 26 (19{\%}) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8{\%}) patients; 4 (2{\%}) had renovascular abnormalities. Yield of echocardiography was 17{\%}. On ambulatory blood pressure monitoring, 47 (60{\%}) children had systolic readings of >95{\%} at least 20{\%} of the time, and 28 (36{\%}) had diastolic readings of >95{\%} at least 20{\%} of the time. Conclusions. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5{\%} to 20{\%} abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.",
keywords = "Ambulatory blood pressure monitoring, Echocardiogram, Essential hypertension, Lipid profile, Metabolic syndrome",
author = "Jonathan Wiesen and Matthew Adkins and Sherwin Fortune and Judah Horowitz and Nava Pincus and Rachel Frank and Suzanne Vento and Cathy Hoffman and Beatrice Goilav and Howard Trachtman",
year = "2008",
month = "11",
doi = "10.1542/peds.2008-0365",
language = "English (US)",
volume = "122",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "5",

}

TY - JOUR

T1 - Evaluation of pediatric patients with mild-to-moderate hypertension

T2 - Yield of diagnostic testing

AU - Wiesen, Jonathan

AU - Adkins, Matthew

AU - Fortune, Sherwin

AU - Horowitz, Judah

AU - Pincus, Nava

AU - Frank, Rachel

AU - Vento, Suzanne

AU - Hoffman, Cathy

AU - Goilav, Beatrice

AU - Trachtman, Howard

PY - 2008/11

Y1 - 2008/11

N2 - Objective. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. Methods. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mm Hg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. Results. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13. 3 ± 4. 4 years. BMI was 26. 1 ± 6. 7 kg/m 2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. Conclusions. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.

AB - Objective. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. Methods. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mm Hg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. Results. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13. 3 ± 4. 4 years. BMI was 26. 1 ± 6. 7 kg/m 2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. Conclusions. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.

KW - Ambulatory blood pressure monitoring

KW - Echocardiogram

KW - Essential hypertension

KW - Lipid profile

KW - Metabolic syndrome

UR - http://www.scopus.com/inward/record.url?scp=58149162859&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149162859&partnerID=8YFLogxK

U2 - 10.1542/peds.2008-0365

DO - 10.1542/peds.2008-0365

M3 - Article

VL - 122

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 5

ER -