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。儿童和青少年血压升高的患病率日益上升，是一个日益重要的临床和公共卫生问题。持续血压升高的青少年在短时间内左心室质量增加，血管反应性改变和cIMT增加。此外，他们往往在成年后发展为高血压，这大大增加了生命后期多种严重临床后遗症的风险。虽然估计有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的稳定性了解非常有限，而且对血压升高的儿童和青少年的护理模式知之甚少，或者这些年龄组血压升高的资源使用影响。该项目将利用通过电子医疗记录（EMR）从科罗拉多州、明尼苏达州和加利福尼亚州的大型医疗集团提取的详细临床数据，解决这些关键的知识缺口。所有研究对象的可用数据包括6年研究期间所有舒张压和收缩压测量值、体重、身高、年龄、性别、种族/民族、合并症、药物和实验室检查结果。这些EMR数据来自8万名0-17岁的儿童和青少年，基线时至少有一次血压升高。这些数据将用于以下具体目的：(i)详细评估最近发展的儿童和青少年高血压前期（Pre-HT）和高血压（HT）类别随时间的稳定性；（ii）评估为血压升高儿童提供的护理模式（包括一系列血压测量、诊断、检查、生活方式干预和药物管理）；（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，结果将(a)为验证或修改最近的工作组建议提供信息，(b)记录目前为血压升高的儿童和青少年提供的护理的优势和不足，以指导未来护理改进举措的设计，(c)为健康计划管理者和支付者量化儿童血压升高的成本。(d)发展先进的电子监测能力，以监测电子病历时代为特定慢性病患者提供的护理模式；(e)确定一个庞大的、定义明确的、自我更新的潜在研究对象群体，用于未来的干预试验，以改善对血压升高或相关疾病的儿童和青少年的护理。公共卫生相关性：本研究考察了高血压儿童的卫生保健状况，将为验证或修改目前的实践建议提供信息，记录目前向儿童和青少年提供的保健的优势和缺陷，并向健康计划管理者和支付者展示儿童血压升高的成本。研究结果将对公共卫生大有裨益，使人们更深入地了解儿童高血压与肥胖之间的关系及其对成年期健康的影响。

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.