Diagnostic tests used in adolescents with essential hypertension reassessed

Experts in pediatric hypertension could benefit from using renal ultrasonography, compared with electrocardiograms or echocardiograms, to rule out potential causes of secondary hypertension, researchers suggest.

In a longitudinal analysis of administrative claims data, researchers from the University of Michigan collected Michigan Medicaid claims and pharmacy data from 2003 to 2008 for adolescents aged 12 to 18 years.

Esther Y. Yoon, MD, MPH, and colleagues identified adolescents with essential hypertension with one or more antihypertensive pharmacy claims and examined echocardiogram, renal ultrasonography and ECG use.

The timing of the three diagnostic tests was also examined as they related to each other or to the first antihypertensive prescription, they said.

“The purpose of this study was to describe patterns of echocardiogram use among adolescents with essential hypertension severe enough to warrant hypertensive pharmacotherapy, in relation to the use of renal ultrasonography and [ECGs]. We hypothesized that echocardiogram use would be similar to that of renal ultrasonography but less than that of [ECGs] because [ECGs] are often more readily available to physicians at the point of care,” the researchers wrote.

Of the 951 patients included in the study population, two-thirds were male; 60% were aged 11 to 14 years at the start of Medicaid eligibility; 44% were black; 51% were white and 4% Hispanic. More than half of the study population had an obesity-related comorbidity (57%), and one-third had 6 years of Medicaid eligibility throughout the study duration, researchers wrote.

During the study, 226 patients (24%) had echocardiograms; 207 had renal ultrasonography (22%); and 478 (50%) had ECGs. According to data, males (OR=1.53; 95% CI, 1.06-2.21), younger adolescents (OR=1.69; 95% CI, 1.17-2.44), those who had ECGs (OR=5.79; 95% CI, 4.02-8.36), and those who had renal ultrasonography (OR=2.22; 95% CI, 1.54-3.20) were more likely to have echocardiograms compared with females, older adolescents and adolescents who did not have an ECG or renal ultrasonography test, researchers wrote.

Yoon and colleagues concluded that their findings could represent missed opportunities on matters of time and efficiency when it comes to diagnostic testing in the treatment of adolescents with hypertension, and it warrants further study.

In an accompanying editorial, Sarah D. de Ferranti, MD, MPH, of the department of cardiology at Boston Children’s Hospital and Harvard Medical School, and Matthew W. Gillman, MD, SM, of Harvard Medical School, said more information is needed to declare any conclusions.

“The answers to the many questions raised here are unclear, pointing to the need for more information about the extent to which the BP guidelines overall, and recommended diagnostic testing in particular, are implemented,” de Ferranti and Gillman wrote.

For more information:

de Ferranti SD. Arch Pediatr Adolesc Med. 2012;doi:10.1001/archpediatrics.2012.1503.
Yoon EY. Arch Pediatr Adolesc Med. 2012;doi:10.1001/archpediatrics.2012.1173.

Disclosure: Dr. de Ferranti has received royalties from UpToDate, serves as a member of the American Academy of Pediatrics Committee on Nutrition and is liaison to the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee. She has also served as an advisory panel and writing group member for the National Lipid Association. Dr. Gillman has also received royalties from UpToDate. All other researchers report no relevant financial disclosures.