Many Teens With High Blood Pressure Don’t Get Needed Tests

MONDAY, July 23 (HealthDay News) — High blood pressure is a
growing problem in teens, partly due to the rising number of obese teens,
and federal guidelines suggest specific tests be done to diagnose the
effects of the condition.

However, fewer than one in four teens with high blood pressure receives
the tests recommended by U.S. National Heart, Lung, and Blood Institute
guidelines, a new study finds. On the other hand, about half of those in
the study received electrocardiograms (EKGs), which are not recommended to
help with diagnosis in children with high blood pressure.

“We found that the most common test used for adolescents was the EKG, a
non-recommended test, and that the recommended tests were both
infrequently used,” said researcher Dr. Esther Yoon, assistant professor
of pediatrics at the University of Michigan, Ann Arbor.

“High blood pressure in teens should not be taken lightly,” Yoon said.
It increases the risk for heart disease and other problems.

The study was published online July 23 in the Archives of Pediatrics
Adolescent Medicine
.

Yoon and her colleagues evaluated claims data from 951 Michigan teens,
aged 12 to 18, with high blood pressure who were Medicaid patients between
2003 and 2008.

Of these, 24 percent, had an echocardiogram. This test uses sound waves
to examine the heart and is recommended to help doctors decide if
medication is needed to treat the high blood pressure.

Just 22 percent, about one in five, got a kidney ultrasound to
determine if the high blood pressure was affecting the kidneys. This test
is also recommended in teens with high blood pressure.

However, half got an EKG, although the guidelines put out by the U.S.
National Heart, Lung, and Blood Institute (NHLBI) don’t recommend this
test in evaluating teens with high blood pressure. An EKG is a noninvasive
test that records electrical activity in the heart.

To determine if a child has high blood pressure, a doctor compares his
or her blood pressure numbers to average numbers for the child’s age,
gender and height, according to the NHLBI.

“There is a lot of hesitation,” Yoon said. Both doctors and parents,
she noted, may explain away a high blood pressure reading in teens,
reasoning that they are nervous about seeing the doctor or worried
temporarily about something.

The findings call for more research, she added. But they suggest that
doctors may not be aware of the guidelines, which Yoon said have been in
place since 2004 and updated since then.

“Better education and training of doctors [is needed] to understand how
best to use these diagnostic tests for kids with high blood pressure,” she
said.

Doctors may be using their clinical judgment in deciding which
recommended tests to do, said Dr. Sarah de Ferranti, director of the
preventive cardiology clinic at Boston Children’s Hospital. She co-wrote
an editorial accompanying the study.

The study looked only at claims data, she said. For that reason, the
study is missing doctors’ reasons for not doing certain tests. For
instance, the teen may have had mild high blood pressure and the doctor
decided to try lifestyle changes first.

Even so, Yoon and de Ferranti said parents can do much to be sure their
child, if diagnosed with high blood pressure, gets the best care
possible.

If your pediatrician or teen medicine doctor tells you your child has
high blood pressure, ask if there is a cause that can be found, de
Ferranti said. Obesity increases the risk of high blood pressure.
Sometimes, an underlying medical condition, such as a kidney problem, can
be causing it.

In many other cases, however, it is what doctors call ”essential
hypertension,” meaning no cause can be found.

Get instructions about lifestyle changes, de Ferranti said. Your
pediatrician may suggest you help your teen start an exercise program,
lower salt in the diet or try to lose weight.

If your teen’s blood pressure is abnormally high at a doctor’s visit,
Yoon said, be sure to follow up. Ask the doctor what to do next. This is
especially important, she said, if there is a family history of high blood
pressure.

The study was funded by the U.S. National Heart, Lung, and Blood
Institute.

More information

To learn more about teens and high blood pressure, visit the Nemours Foundation.

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