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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

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Pediatric hypertension: diagnostic patterns derived from electronic health records

Goutham Rao
  • Corresponding author
  • Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-4915, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Sara Naureckas / Avisek Datta / Nivedita Mohanty / Victoria Bauer
  • Ambulatory Primary Care Innovations Group, NorthShore University Health System, Evanston, IL, USA
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  • De Gruyter OnlineGoogle Scholar
/ Roxane Padilla / Sarah S. Rittner / Sandra Tilmon / Paul Epner
Published Online: 2018-08-21 | DOI: https://doi.org/10.1515/dx-2018-0010



Pediatric hypertension is a serious problem associated with target organ damage in children and an increased risk for adult hypertension. African-American and Latino children are disproportionately affected. Unfortunately, due to a variety of factors, including the complexity of blood pressure (BP) standards, pediatric hypertension is undiagnosed in the majority of cases. We sought to identify factors associated with correct diagnosis and to better understand diagnosis of hypertension by studying the diagnostic paths of a small number of children.


Data were extracted from electronic health records (EHRs) of children who met criteria for hypertension. Logistic regression was used to identify factors associated with correct diagnosis. Diagnostic paths for 20 diagnosed children were extracted through chart review and analyzed.


Among 1478 hypertensive children, only 85 were diagnosed (6.1%). Age ≥12 compared to age ≤6 was associated with correct diagnosis [odds ratio (OR) of 1.96, 95% confidence interval (CI) (1.16, 3.32)]. Diagnostic paths revealed that primary care providers (PCPs) make the diagnosis based on multiple readings over time and order laboratory tests appropriately.


Hypertension is missed in a large proportion of all children. Effective, systematic approaches to diagnosis are necessary.

Keywords: children; diagnosis; hypertension


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About the article

Corresponding author: Goutham Rao, MD, Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-4915, USA

Received: 2018-04-09

Accepted: 2018-07-25

Published Online: 2018-08-21

Published in Print: 2018-09-25

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: Agency for Health Care Research and Quality, R21 HS024100.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, Volume 5, Issue 3, Pages 157–160, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0010.

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