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- Title
Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring – characteristics associated with inertia and action.
- Authors
van Gelderen, Evelien; Psoter, Kevin J.; Faria, Rafi; Pruette, Cozumel; Brady, Tammy M.
- Abstract
Background: Ambulatory 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. Methods: This 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. Results: 115 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. Conclusions: While 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.
- Subjects
MARYLAND; CROSS-sectional method; BEHAVIOR modification; T-test (Statistics); AFRICAN Americans; HYPERTENSION; PHYSICIANS' attitudes; RETROSPECTIVE studies; CHI-squared test; DESCRIPTIVE statistics; ANTIHYPERTENSIVE agents; CHRONIC kidney failure; PHYSICIAN practice patterns; HEALTH behavior; DIASTOLIC blood pressure; AMBULATORY blood pressure monitoring; COUNSELING; CHILDHOOD obesity; SYSTOLIC blood pressure; MASKED hypertension; REGRESSION analysis
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 9, p2725
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-024-06404-7