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Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring – characteristics associated with inertia and action.
- Source :
-
Pediatric Nephrology . Sep2024, Vol. 39 Issue 9, p2725-2732. 8p. - Publication Year :
- 2024
-
Abstract
- Background: Ambulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings. Methods: This was a retrospective cross-sectional analysis of patients 5–22 years old who underwent 24-h ABPM between 2003–2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action. Results: 115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action. Conclusions: While most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CROSS-sectional method
*BEHAVIOR modification
*T-test (Statistics)
*AFRICAN Americans
*HYPERTENSION
*PHYSICIANS' attitudes
*RETROSPECTIVE studies
*CHI-squared test
*DESCRIPTIVE statistics
*ANTIHYPERTENSIVE agents
*CHRONIC kidney failure
*PHYSICIAN practice patterns
*HEALTH behavior
*DIASTOLIC blood pressure
*AMBULATORY blood pressure monitoring
*COUNSELING
*CHILDHOOD obesity
*SYSTOLIC blood pressure
*MASKED hypertension
*REGRESSION analysis
Subjects
Details
- Language :
- English
- ISSN :
- 0931041X
- Volume :
- 39
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Pediatric Nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 178622921
- Full Text :
- https://doi.org/10.1007/s00467-024-06404-7