Dr Tammy Brady on the Dangers of Missed, Incorrect Hypertension Diagnoses in Children

Correctly diagnosing hypertension in children is crucial for identifying other underlying conditions and allowing for earlier treatment and better outcomes, explained Tammy Brady, MD, PhD, medical director of the Pediatric Hypertension Program and associate professor of pediatrics at Johns Hopkins University.

Transcript

What are the dangers of missed or incorrect diagnosis of hypertension in children?

Hypertension in childhood is often the result of another condition, frequently related to the kidney but can also be related to rheumatologic diseases, endocrine disorders, and so elevated blood pressure is often the first sort of sign that there’s something else going on. And so by missing elevated blood pressure, underdiagnosing this, you’re missing an opportunity to diagnose and identify another condition, and many of those conditions, the earlier that they’re identified and treated really can be the most impactful in terms of the outcomes.

As an example, in pediatric nephrology, say a child who has focal segmental glomerulosclerosis, he or she may feel fine and have no outward signs that anything is going on with their kidney; however, they may have an elevated blood pressure that’s identified at their primary care doctor for whatever reason, and that elevated blood pressure will prompt a work-up that will ultimately identify proteinuria and elevated creatinine, and that will allow for earlier intervention and earlier treatment, which can delay kidney disease progression and potentially even prevent end-stage renal disease from developing.

In terms of overdiagnosis, certainly with overdiagnosis comes the risk of having overutilization, overtesting, potentially inducing anxiety in the child or the family, but I actually in my experience find this to be less of a problem. Certainly this is a problem if you rely on the first blood pressure that’s obtained in a clinic setting, but the American Academy of Pediatrics has really tried to emphasize the need for repeated measurements in a clinic setting over repeated visits and additionally the use of ambulatory blood pressure monitoring prior to even giving a child a diagnosis of hypertension or even initiating a work-up. And so hopefully as these guidelines get more broadly implemented, overdiagnosis will be less of a problem.