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不断上升，是一个日益重要的临床和公共卫生问题。青少年血压持续升高会在短时间内发生左心室质量增加、血管反应性改变和cIMT增加。此外，他们通常在成年后发展为后续高血压，这大大增加了以后生活中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年儿童和青少年高血压第四次报告最近建立的血压分类类别随时间推移的稳定性了解非常有限，并且对向血压升高的儿童和青少年提供的护理模式知之甚少，或者这些年龄段血压升高对资源使用的影响。该项目将使用通过科罗拉多、明尼苏达和加州大型医疗集团的电子病历（EMR）提取的详细临床数据来解决这些关键的知识差距。所有研究受试者的可用数据包括6年研究期间的所有舒张压和收缩压测量值、体重、身高、年龄、性别、人种/种族、合并症、药物和实验室检查结果。这些EMR数据来自基线时至少有一次血压升高的80，000名0 - 17岁儿童和青少年的估计研究人群。这些数据将用于实现以下具体目标：（i）详细评估最近开发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）评估向血压升高儿童提供的护理模式（包括连续血压测量、诊断、检查、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卫生保健资源使用的影响。通过解决这些具体目标，研究结果将（a）提供信息，以验证或修改最近的工作组建议，（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，以指导未来护理改进措施的设计，（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，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，以及（e）确定一个大型的、定义明确的，和自我更新的潜在研究对象的人口，为未来的干预试验，以改善儿童和青少年血压升高或相关条件的照顾。公共卫生相关性：这项研究，检查高血压儿童的卫生保健状况，将提供信息，以验证或修改目前的实践建议，文件的优势和缺陷，目前提供给儿童和青少年的护理，并证明健康计划管理人员和支付儿童血压升高的成本。研究结果将有助于更深入地了解儿童期高血压与肥胖之间的关系及其对成年期健康的影响，从而对公共卫生大有裨益。

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.