Abstract
Elevated blood pressures often go unrecognized in pediatric patients, potentially putting children and adolescents at risk for the sequelae of untreated hypertension. This may be partially due to the complexity involved in diagnosing elevated pediatric blood pressures, which demands a high cognitive workload from providers. Tools built into electronic health records have the potential to alleviate this workload, and studies investigating these tools confirm they show promise in improving elevated blood pressure recognition. However, the current tools are not perfect, and determining the optimal design and implementation of future iterations requires further study. The proper integration of patient-generated blood pressure readings, such as those obtained during ambulatory blood pressure monitors, also requires careful consideration.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of major importance
• Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298(8):874–9. The first study demonstrating the problem of under-recognition of elevated blood pressure in pediatrics.
Brady TM, Solomon BS, Neu AM, et al. Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children. Pediatrics. 2010;125(6):e1286–93.
Shapiro DJ, Hersh AL, Cabana MD, et al. Hypertension screening during ambulatory pediatric visits in the United States, 2000–2009. Pediatrics. 2012;130(4):604–10.
Sleeper EJ, Ariza AJ, Binns HJ. Do hospitalized pediatric patients have weight and blood pressure concerns identified? J Pediatr. 2009;154(2):213–7.
Ricke TL, Hendry PL, Kalynych C, et al. Incidence and recognition of elevated triage blood pressure in the pediatric emergency department. Pediatr Emerg Care. 2011;27(10):922–7.
Beckett LA, Rosner B, Roche AF, et al. Serial changes in blood pressure from adolescence into adulthood. Am J Epidemiol. 1992;135(10):1166–77.
Sun SS, Grave GD, Siervogel RM, et al. Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics. 2007;119(2):237–46.
Lauer RM, Clarke WR, Mahoney LT, et al. Childhood predictors for high adult blood pressure: the Muscatine Study. Pediatr Clin N Am. 1993;40(1):23–40.
Bao W, Threefoot SA, Srinivasan SR, et al. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995;8(7):657–65.
Juhola J, Magnussen CG, Viikari JS, et al. Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. J Pediatr. 2011;159(4):584–90.
Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–e209.
Bello JK, Mohanty N, Bauer V, et al. Pediatric hypertension: provider perspectives. Glob Pediatr Health. 2017;4:2333794X17712637.
Samuels JA, Bell C, Flynn JT. Screening children for high blood pressure: where the US preventive Services Task Force went wrong. J Clin Hypertens. 2013;15(8):526–7.
• Cha SD, Chisolm DJ, Mahan JD. Essential pediatric hypertension: defining the educational needs of primary care pediatricians. BMC Med Educ. 2014;14:154. Gives provider perspectives on the challenges involved in addressing high blood pressure in children and adolescents
Zaheer S, Watson L, Webb NJ. Unmet needs in the measurement of blood pressure in primary care. Arch Dis Child. 2014;99(5):463–4.
Gillman MW. Childhood prevention of hypertensive cardiovascular disease. J Pediatr. 2009;155(2):159–61.
Ward RL, Robbins JM, Haden RN, et al. Recognition and management of elevated blood pressure in pediatric patients: challenges and disparities in community health centers. J Community Health. 2016;41(2):258–64.
Parker ED, Sinaiko AR, Daley MF, et al. Factors associated with adherence to blood pressure measurement recommendations at pediatric primary care visits, Minnesota and Colorado, 2007–2010. Prev Chronic Dis. 2015;12:E118.
Blumenthal S, Epps RP, Heavenrich R, et al. Report of the task force on blood pressure control in children. Pediatrics. 1977;59((5 2 suppl):I-II):797–820.
•• Flynn JT, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3). The most up-to-date guidelines on the diagnosis and management of pediatric hypertension.
• Hart SG, Staveland EL. Development of NASA-TLX (Task Load Index): results of empirical and theoretical research. Adv Psychol. 1988;52:139–83. Describes the development of a subjective measure of cognitive workload
Lim J, Wu WC, Wang J, et al. Imaging brain fatigue from sustained mental workload: an ASL perfusion study of the time-on-task effect. NeuroImage. 2010;49(4):3426–35.
Gui D, Xu S, Zhu S, et al. Resting spontaneous activity in the default mode network predicts performance decline during prolonged attention workload. NeuroImage. 2015;120:323–30.
Available at https://humansystems.arc.nasa.gov/groups/tlx/. Accessed 20th September 2017.
Ahmed A, Chandra S, Herasevich V, et al. The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance. Crit Care Med. 2011;39(7):1626–34.
•• Brady TM, Neu AM, Miller ER 3rd, et al. Real-time electronic medical record alerts increase high blood pressure recognition in children. Clin Pediatr (Phila). 2015;54(7):667–75. Retrospective cohort study evaluating the effect of an electronic alert on hypertension recognition
•• Kharbanda EO, Nordin JD, Sinaiko AR, et al. TeenBP: development and piloting of an EHR-linked clinical decision support system to improve recognition of hypertension in adolescents. EGEMS (Wash DC). 2015;3(2):1142. Provides a good summary and implementation of the design of an electronic alert for high blood pressure
•• Twichell SA, Rea CJ, Melvin P, et al. The effect of an electronic health record-based tool on abnormal pediatric blood pressure recognition. Congenit Heart Dis. 2017;12(4):484–90. Evaluates the impact of an optional tool on elevated blood pressure recognition
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author declares no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Pediatric Hypertension
Rights and permissions
About this article
Cite this article
Semanik, M.G. The Use of Electronic Health Records to Identify Children with Elevated Blood Pressure and Hypertension. Curr Hypertens Rep 19, 98 (2017). https://doi.org/10.1007/s11906-017-0794-2
Published:
DOI: https://doi.org/10.1007/s11906-017-0794-2