Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

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FIGURE 1
Study population and substudy populations. HTN, hypertension; preHTN, prehypertension.
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FIGURE 2
Overall and sex and age distribution of antihypertensive medication initially prescribed in study population with diagnosed hypertension within 12 months. N = 170 drugs among 158 patients ages 3–9 years (○○○○), 10–14 years (+), and 15–18 years (×), and over all ages and sexes (∆).CCB, calcium channel blocker.

TABLE 1

Characteristics of HTN and preHTN Substudy Populations

			HTN Substudy Population		preHTN Substudy Population
	Study Population, N = 398 079	HTN, N = 12 138	HTN With Diagnosis, N = 2813	Anti-HTN Prescription, N = 158	preHTN, N = 38 874	preHTN With Diagnosis, N = 3990
Average age, y (SD)	9.4 (4.0)	9.1 (3.8)	10.3 (3.9)	11.3 (3.7)	10.8 (4.1)	11.6 (3.9)
Average BMI percentile (SD)	63.8 (28.9)	76.3 (27.2)	84.1 (23.7)	82.1 (23.9)	73.6 (26.9)	81.9 (23.7)
Female, %	48.9	52.6	46.1	40.5	40.1	31.0
Male, %	51.1	47.4	53.9	59.5	59.9	69.0
Normal, %^a	68.1	45.5	30.4	36.7	52.0	35.7
Overweight, %	15.8	16.8	15.5	16.5	18.6	18.0
Obese, %	16.1	37.7	54.0	46.8	29.4	46.3
Caucasian, %	42.2	43.3	32.5	27.2	43.6	33.4
African American, %	25.8	33.1	42.6	39.2	31.1	40.8
Other, %	6.3	6.7	4.9	4.4	6.4	4.1
American Indian or Alaskan, %	0.3	0.2	0.1	0.0	0.3	0.3
Asian or Pacific Islander, %	1.5	1.6	0.8	0.6	1.4	0.7
Mixed racial group, %	0.6	0.5	0.7	0.6	0.5	0.8
Missing race, %	23.3	14.6	18.4	27.9	16.9	20.0
Hispanic or Latino, %	7.3	8.2	9.0	12.7	6.9	8.5
Not Hispanic or Latino, %	54.0	64.9	60.2	54.4	58.5	56.0
Missing ethnicity, %	38.7	26.9	30.8	32.9	34.6	35.5
Public insurance reported, %^b	32.4	44.3	54.4	52.5	36.1	45.5
Public insurance not reported, %	37.4	40.0	30.1	26.6	43.7	35.2
Missing insurance, %	30.2	15.7	15.5	20.9	20.2	19.4

HTN, hypertension; preHTN, prehypertension; SD, standard deviation.
↵a Recorded at third BP measurement.
↵b Public insurance reported refers to those who ever indicated public insurance in the data, versus those who never indicated public insurance. Those who had no insurance data collected are not listed.

TABLE 2

Standardized Percentages of Children With Diagnosis of Hypertension

Demographic Factor, n = 12 138	Standardized Percentage (95% CI)	Overall Within-Factor Difference, P
Age category, y		<.001
3–9	20.3 (19.4–21.1)
10–14	29.6 (28.2–31.0)
15–18	27.2 (23.4–31.1)
Weight, %		<.001
Normal	18.2 (17.2–19.1)
Overweight	23.1 (21.4–24.8)
Obese	28.8 (27.6–30.0)
Height, %		<.001
Not tall	23.0 (22.3–23.7)
Tall	31.7 (27.2–36.1)
Sex, %		<.001
Female	20.7 (19.8–21.6)
Male	26.2 (25.2–27.2)
Stage 2 range BP readings, %		<.001
No	19.3 (18.4–20.2)
Yes	27.9 (26.8–29.1)
No. of abnormal BP readings >3, %		<.001
No extra readings	18.0 (17.2–18.9)
1 extra reading	24.9 (23.5–26.4)
2 extra readings	30.9 (28.5–26.4)
≥3 extra readings	37.1 (34.7–39.5)

All estimates are standardized (adjusted). Models using logistic regression and predictive margins for standardization included age, weight, height, sex, presence of BP readings in stage 2 range, and number of abnormal BP readings >3. All models also include clinical practice site as a covariate because variation across sites in the rate of diagnosis and the characteristics of patients induces confounding by practice. Estimates therefore can be interpreted as the adjusted percentage of children who received a diagnosis of hypertension within practice sites (and averaged across practice sites), controlling for their individual differences.

TABLE 3

Standardized Percentages of Children With Diagnosis of Prehypertension

Demographic Factor, n = 38 874	Standardized Percentage (95% CI)	Overall Within-Factor Difference, P
Age category, y		<.001
3–9	9.3 (8.8–9.7)
10–14	11.0 (10.6– 11.5)
15–18	11.7 (10.6–12.9)
Weight, %		<.001
Normal	7.7 (7.4–8.1)
Overweight	9.5 (8.9–10.2)
Obese	14.7 (14.1–15.3)
Height, %		.011
Not tall	10.2 (9.9–10.5)
Tall	11.7 (10.6–12.8)
Sex, %		<.001
Female	8.2 (7.7–8.6)
Male	11.7 (11.3–12.1)
Stage 2 range BP readings, %		<0.001
No	9.4 (9.1–9.7)
Yes	19.4 (18.1–20.6)
No. of abnormal BP readings >3, %		<.001
No extra readings	8.3 (7.9–8.7)
1 extra reading	11.4 (10.8–12.0)
2 extra readings	13.7 (12.7–14.8)
≥3 extra readings	18.0 (16.6–19.4)

All estimates are standardized (adjusted). Models using logistic regression and predictive margins for standardization included age, weight, height, sex presence of BP readings in stage 2 range, and number of abnormal BP readings >3. All models also include clinical practice site as a covariate because variation across sites in the rate of diagnosis and the characteristics of patients induces confounding by practice. Estimates therefore can be interpreted as the adjusted percentage of children who received a diagnosis of prehypertension within practice sites (and averaged across practice sites), controlling for their individual differences.