Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring - characteristics associated with inertia and action.

Evelien van Gelderen, Kevin J Psoter, Rafi Faria, Cozumel Pruette, Tammy M Brady

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Article in Pediatric nephrology (Berlin, Germany), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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5 authors.

Evelien van GelderenJohns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA.ORCID 0009-0007-1401-0022

Kevin J PsoterJohns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA.

Rafi FariaJohns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA.

Cozumel PruetteJohns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA.

Tammy M BradyJohns Hopkins Pediatrics, Johns Hopkins University School of Medicine, Rubenstein Child Health Building Suite 3057, 200 N Wolfe St, Baltimore, MD, 21287, USA. tbrady8@jhmi.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAmbulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings.

methodsThis was a retrospective cross-sectional analysis of patients 5-22 years old who underwent 24-h ABPM between 2003-2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action.

results115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action.

conclusionsWhile most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized.

Indexed as

Blood Pressure Monitoring, AmbulatoryHypertensionAdolescentAntihypertensive AgentsBlood PressureChildChild, PreschoolCounselingCross-Sectional StudiesFemaleHumansMaleMasked HypertensionPractice Patterns, Physicians'Retrospective StudiesYoung AdultAntihypertensive AgentsAdolescentsCardiovascular diseaseChildrenClinical decision-makingHypertension

Identifiers

PMID38761222

DOI10.1007/s00467-024-06404-7

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.