Can we recognize childhood hypertension without the use of reference tables

s ingediend voor het Amsterdam Kindersymposium 2013 25 Can we recognize childhood hypertension without the use of reference tables? Hester Bluf pand, Merijn Bijlsma, Arend Bokenkamp Pediatric Nephrology and Oncology, VU University Medical Center INTRODUCTION Screening for childhood hypertension is increasingly advocated. However, recent studies have shown that even when blood pressure (BP) is measured and recorded, the majority of hypertensive cases are left undiagnosed. We hypothesized that unfamiliarity with normal BP values combined with the selective use of reference tables might explain the under diagnosis of childhood hypertension. METHODS A cross-sectional multicenter survey among Dutch pediatricians and pediatric residents was conducted using a questionnaire including items on frequency of BP measurement, the use of reference tables and familiarity with defi nitions of (pre)hypertension. In 12 case histories BP had to be classifi ed on the basis of age, gender and height-SDS (6 cases normotensive, 2 pre-, 2 stage I and 2 stage II hypertension). The questionnaires were completed with the researchers present and without access to reference tables. RESULTS 139 respondents (58% pediatricians) with a median experience of 9 years (IQR 3-15) participated. Respectively 87% and 80% gave the correct defi nition of prehypertension and hypertension. 71% reported only measuring BP when a child has a disease or risk factor associated with hypertension, whereas 65% reported only using reference tables when a BP value seemed high. Classifi cation of high BP was correct in 39% (prehypertension), 49% (stage I) and 59% (stage II) of the case histories. Pediatricians scored slightly better than residents (p=0.048). CONCLUSION BP is not measured routinely and reference tables are selectively consulted, often only if a BP seems high. However ‘at fi rst sight’ recognition of high BP without consulting reference tables is poor.