Survey reveals that 40% of pediatricians are uncomfortable evaluating and treating hypertension


CHICAGO —A survey of general pediatricians showed that 84% of them refer more than two thirds of their adolescent hypertensives to either a nephrologist or cardiologist, researchers reported here at the 22nd Annual Meeting of the American Society of Hypertension. 

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The survey revealed that 40% of pediatricians were “uncomfortable with the evaluation and treatment of hypertension.” Seventy-two percent of the pediatricians cited a lack of expertise as a reason for their discomfort. Miss-ing a case of secondary hypertension, the tendency of adolescents to be lost to follow-up, and a lack of familiarity with anti-hypertensive medications were reported by 34%, 17%, and 3% of participants, respectively.


Alexis Boneparth, MD, a resident in pediatrics at the Children’s Hospital of Montefiore in the Bronx, N.Y., and his associates analyzed the results of questionnaires completed by 89 pediatricians that were designed to determine how pediatricians approach children with hypertension. In addition to pediatricians who referred patients to the Children’s Hospital of Montefiore, the survey included those physicians attending a continuing medical education conference. Overall, 94% of pediatricians said they started screening their patients for hypertension at three years of age.


As part of the survey, participants were queried about their choice of tests in the initial evaluation of the asymptomatic hypertensive patient. A chem-7 was obtained by 99% of pediatricians, urinalysis by 94%, a complete blood count by 71%, fasting lipid studies by 57%, thyroid function tests by 55%, a urine culture by 22%, and a renal ultrasound by 20%.


Pediatricians who were familiar with the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents were much more likely to be comfortable in the evaluation and management of young hypertensives.    


The study also found that 58% of physicians ascribed their failure to initiate pharmacologic treatment to a lack of familiarity with anti-hypertensive drug therapy. Additionally, 18% cited concern about potential side effects, 17% cited the tendency for adolescents to be noncompliant with prescribed therapy, 15% cited a preference for specialist referral, and 11% cited uncertainty about the long-term risks of hypertension in pediatric patients.


Dr. Boneparth said that more studies are needed to determine whether these results “from a relatively small, urban survey population with easy access to pediatric specialists” will be replicated in larger, more diverse populations.