sured. Over 12,000
(3%) of these children met criteria
for hypertension as
defined by the National Heart, Lung,
Analyses were designed to identify children who had
repeated measures of high blood pressure that qualified
for diagnosis of hypertension based on NHLBI criteria.
Among children who met criteria for hypertension,
researchers then looked at whether any diagnosis of
hypertension or prescription for antihypertensive medication was found during the study period.
Results showed that of 12,138 children who met
NHLBI criteria for hypertension with measures of
blood pressure higher than the 95th percentile at three
or more separate clinic visits, only 23% ( 2,813) had a
diagnosis of hypertension. Among the 2,813 children
who did have a diagnosis of hypertension, less than
6% (158) were prescribed antihypertensive medication within 12 months of diagnosis. (See figure.) Those
who did receive medications were prescribed angioten-sin-converting-enzyme inhibitors or blockers (35%),
diuretics (22%), calcium channel blockers (17%) and
The study also measured the percentage of children
who met NHLBI criteria for pre-hypertension and
whether those children had a diagnosis of pre-hypertension. Results showed that of the 398,079 children who
had at least three blood pressure measurements, 9.8%
met the criteria for pre-hypertension but only 10% of
those with pre-hypertension received a diagnosis.
This study highlights the power of large datasets to
examine questions about uncommon conditions or
conditions with infrequent treatment. The large cohort
allowed researchers to detect the small percentage of
children who were diagnosed with and received medication treatment for hypertension.
This study involved collaboration among pediatric practices from the AAP PROS Network; the AAP
Comparative Effectiveness Research through Collaborative Electronic Reporting Consortium Research
Team; and researchers from the MetroHealth System
and Case Western Reserve in Cleveland, the Children’s
Hospital of Philadelphia (CHOP), The University of
Pennsylvania, University of Vermont and the Academy.
The project was supported in part by the Health
Resources and Services Administration of the U.S.
Department of Health and Human Services (HHS)
with the National Institutes of Child Health and
Human Development under grants R40MC24943,
UB5MC20286 and UA6MC15585; CHOP; and the
Academy. This content and conclusions are those of
the authors and should not be construed as the official
position or policy of, nor should any endorsements be
inferred by HHS or the U.S. government.
Prevalence of hypertension (HTN) symptoms, clinical diagnosis (Dx)
and medication treatment among U.S. children in primary care
12,138 (3%) HTN
38,874 ( 9.8%) Pre-HTN
38,874 ( 9.8%)
158 ( 5.6%)
HTN Clinical Dx Medication
• For more information about PROS, visit http://www2.
aap.org/pros or contact Laura Shone, in the AAP Division of Primary Care Research, at 847-434-7910 or
• Education in Quality Improvement for Pediatric Practice
course: Hypertension Identification and Management,
• The Fourth Report on the Diagnosis, Evaluation, and
Treatment of High Blood Pressure in Children and Ad-
• Information for parents on high blood pressure in
children (available in English and Spanish), http://bit.