Abstract 11053: Prevalence of Hypertension, Cardiac Complications and Anti-hypertensive Medication Use in Children
In 2003, the American Heart Association updated its statement on prevention of cardiovascular disease to include recognition that adult cardiovascular disease begins in childhood. The 2004 NIH-NHLBI guidelines recommended echocardiogram for all children with hypertension (HTN). This study determines the prevalence of HTN diagnosis, use of echocardiography, recognition of complications and use of anti-HTN medications in children in the post-2004 guideline era.
Methods: A retrospective cohort was formed from enrollees 2-18 years of age in the Military Health System database 2006-2011. Outpatient diagnoses of HTN and cardiac complications were identified by ICD-9-CM codes. Confirmed-HTN cases were defined as two or more visits with HTN diagnosis during any calendar year or one visit if with a cardiologist or nephrologist. Echocardiograms were identified by CPT codes. Pharmacy prescriptions for anti-HTN medications were extracted for all subjects. Trends were examined with Cochran-Armitage test of trend.
Results: During 2006-2011, the database contained an average of 1.3 million subjects per year aged 2-18 years with 36% enrolled at civilian facilities. Cardiology evaluations were predominately, 80%, at civilian facilities. A single diagnosis of primary or unspecified HTN was identified in 26,279 unique patients (4.2/1000). The prevalence of Confirmed-HTN increased 17% from 2006 (2.3/1000) to 2011 (2.7/1000, p<0.001). Among Confirmed-HTN patients, 5,585 (34%) had an echocardiogram. The rate of echocardiograms per year increased from 22.7% to 27.7% (p<0.001). Overall, in patients with an echocardiogram, 8.0% had cardiac complications. Of Confirmed-HTN patients, 2,035 (12.5%) received anti-hypertensive medications.
Conclusions: Rates of confirmed HTN diagnosis in children have substantially increased. Although there has been an increase in echocardiography for children with HTN, compliance with national guidelines remains poor. Of pediatric HTN patients who receive an echocardiogram, 1 in 12 have identified cardiac complications, supporting the AHA guidelines for echocardiography in children with HTN. Despite recommendations for anti-HTN medication use, only 12.5% of hypertensive children are treated with medication.
- © 2013 by American Heart Association, Inc.