Screening checks in adolescents with hypertension diverge from guidelines

By Piriya Mahendra, MedWire News Reporter

Guideline-recommended diagnostic tests for hypertension complications, such as echocardiograms and renal ultrasonography, are being poorly used in adolescents, a study suggests.

Esther Yoon (University of Michigan, Ann Arbor, USA) and co-authors found that from 2003 to 2008 in Michigan, only one-quarter of the 2724 hypertensive adolescents with an antihypertensive prescription had at least one echocardiogram (n=226) or one renal ultrasonography (n=207).

In contrast, 50% of adolescents with essential hypertension who had an antihypertensive prescription had at least one electrocardiogram (ECG; n=478), "a diagnostic test that is not recommended by pediatric hypertension guidelines but one that is recommended for adults with hypertension," comment the researchers.

Multivariate analysis revealed that males, younger adolescents (11-14 years compared with 15-19 years), those who had ECGs, and those who had renal ultrasonography were at an increased chance of having an echocardiogram, at respective odds ratios of 1.53, 1.69, 5.79, and 2.22.

Two-thirds of the cohort were male and 60% were aged 11-14 years at the start of Medicaid eligibility. In addition, 44% of adolescents were Black, 51% White, and 4% Hispanic.

"Although national guidelines recommend that all pediatric patients with hypertension get an echocardiogram to assess for target organ damage, only one-quarter of adolescents did so in our study," remark the authors.

In a related commentary, Sarah de Ferranti and Matthew Gillman, both from the Harvard Medical School in Boston Massachusetts, USA, say that the reason behind the low numbers of hypertensive adolescents receiving recommended screening could be because healthcare providers do not agree with the published guidelines.

"Indeed, the evidence base for the guidelines contains a large dose of expert opinion rather than evidence-based conclusions."

They conclude: "Future revision of the guidelines 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."

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