Childhood Hypertension and Obesity: Diagnosis, Care, and Costs

描述(由申请人提供)：儿童和青少年高血压：诊断、护理和费用。儿童和青少年中血压升高的患病率不断上升，这是一个日益重要的临床和公共卫生问题。持续高血压(BP)的青少年在短时间内出现左心室重量增加、血管反应性改变和CIMT增加。此外，他们成年后往往会发展为随后的高血压，这大大增加了日后出现多种严重临床后遗症的风险。尽管估计有7%的儿童和青少年血压升高，但我们对2004年第四次儿童和青少年高血压报告最近建立的血压分类类别随时间的稳定性了解非常有限，对向血压升高的儿童和青少年提供的护理模式或这些年龄组中血压升高对资源使用的影响知之甚少。该项目将使用科罗拉多州、明尼苏达州和加利福尼亚州的大型医疗集团通过电子医疗记录(EMR)提取的详细临床数据来解决这些关键的知识差距。所有研究对象的可用数据包括所有舒张压和收缩压测量、体重、身高、年龄、性别、种族/民族、共病情况、药物和6年研究期间的实验室测试结果。这些EMR数据来自于基线时年龄在0-17岁的8万名儿童和青少年的估计研究人群，这些儿童和青少年至少有一项血压升高。这些数据将被用来解决以下具体目标：(I)详细评估最近在儿童和青少年中开发的高血压前期(Pre-HT)和高血压(HT)类别的稳定性，(Ii)评估为有血压升高的儿童提供的护理模式(包括系列血压测量、诊断、体检、生活方式干预和药物管理)，以及(Iii)评估血压升高对儿童和青少年医疗资源使用的影响。通过解决这些具体目标，成果将：(A)提供信息，以验证或修改工作队最近的建议；(B)记录目前向血压升高的儿童和青少年提供的护理的优势和不足，以指导未来护理改善举措的设计；(C)为健康计划管理者和付款人量化儿童血压升高的成本；(D)发展电子监测在电子病历时代向患有特定慢性病的人提供的护理模式的复杂能力；以及(E)确定一个大型、明确、以及潜在研究对象的自我刷新人群，用于未来的干预试验，以改善对患有高血压或相关疾病的儿童和青少年的护理。公共卫生相关性：这项研究考察了高血压儿童的医疗保健状况，将提供信息来验证或修改当前的实践建议，记录目前向儿童和青少年提供的保健的优势和不足，并向健康计划管理者和支付者证明儿童血压升高的成本。这一结果将有助于更深入地了解儿童高血压和肥胖症之间的关系，以及它对成年后健康的影响，从而对公众健康大有裨益。

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.