Childhood Hypertension and Obesity: Diagnosis, Care, and Costs

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DESCRIPTION (provided by applicant): Child & Adolescent Hypertension: Diagnosis, Care, and Costs. The rising prevalence of elevated BP in children and adolescents is a clinical and public health problem of increasing importance. Adolescents with sustained elevated blood pressure (BP) develop increased left ventricular mass, altered vascular reactivity and increased cIMT within a short period of time. Moreover, they often progress to subsequent hypertension as adults, which substantially increase risk of multiple serious clinical sequels' later in life. Although an estimated 7% of children and adolescents have elevated BP, we have only a very limited understanding of the stability over time of BP classification categories recently established by the Fourth Report on High Blood Pressure in Children and Adolescents in 2004, and little is known about patterns of care provided to children and adolescents with elevated BP, or the resource use implications of elevated BP in these age groups. This project will address these critical gaps in knowledge using detailed clinical data extracted through Electronic Medical Records (EMR) at large medical groups in Colorado, Minnesota, and California. Available data for all study subjects includes all diastolic and systolic BP measures, weight, height, age, gender, race/ethnicity, comorbid conditions, medications, and laboratory test results over a 6-year study period. These EMR data are derived from an estimated study population of 80,000 children and adolescents age 0-17 years at baseline with at least one elevated BP. These data will be used to address the following specific aims: (i) Assess in detail the stability over time of the recently developed categories of Pre-Hypertension (Pre-HT) and hypertension (HT) in children and adolescents, (ii) assess patterns of care provided to children with elevated BP (including serial BP measurement, diagnosis, work-up, lifestyle interventions, and pharmacologic management), and (iii) assess the impact of elevated BP on health care resource use in children and adolescents. By addressing these specific aims, results will (a) provide information to validate or modify recent Task Force recommendations, (b) document strengths and deficits in care currently provided to children and adolescents with elevated BP to guide the design of future care improvement initiatives, (c) quantify for health plan managers and payers the cost of elevated BP in children, (d) develop sophisticated capability for electronic surveillance of patterns of care provided to those with specific chronic diseases in the EMR era, and (e) identify a large, well-defined, and self-refreshing population of potential study subjects for future intervention trials to improve care for children and adolescents with elevated BP or associated conditions. Public Health Relevance: This study, examining the status of health care for children with high blood pressure, will provide information to validate or modify current practice recommendations, document strengths and deficits in care currently provided to children and adolescents, and demonstrate to health plan managers and payers the cost of elevated BP in children. The results will be of great benefit to public health by providing a deeper understanding of the relationship between childhood hypertension and obesity and its' impact on health in adulthood.