According to a study of teenagers with hypertension participating in the Michigan Medicaid program, guideline-recommended diagnostic tests – echocardiograms and renal ultrasonography – were not used effectively.

The study is published in Archives of Pediatrics & Adolescent Medicine.

High blood pressure is an increasing problem for adolescents given that the condition is associated with obesity. According to recommendations from current pediatric guidelines, all pediatric patients with high blood pressure should receive laboratory tests and renal ultrasonography to rule out renal (kidney) disease and echocardiograms to assess target organ damage.

However, scientists know little about using echocardiogram in pediatric patients in comparison with other recommended diagnostic tests, such as renal ultrasonography and other tests that are not included in the recommendation, yet which are more widely available tests like electrocardiograms (EKGs).

In an analysis of administrative claims data from the Michigan Medicaid program from 2003 to 2008, Esther Y. Yoon, M.D., M.P.H., and colleagues of the University of Michigan, Ann Arbor, analyzed echocardiogram use in teenagers and compared it with EKG and renal ultrasonography use.

According to the researchers, of the 951 teenagers with “essential” hypertension (i.e., the cause is unknown):

  • 50% had EKGs
  • 24% had echocardiograms
  • 22% had renal ultrasonography

The researcher explain:

“Our study describes for the first time, to our knowledge, equally low levels of obtaining echocardiograms and renal ultrasonography, which are recommended by national hypertension guidelines, by adolescents with essential hypertension.

In contrast, we found that one-half of adolescents with essential hypertension had at least one EKG during the study period, a diagnostic test that is not recommended by pediatric hypertension guidelines but one that is recommended for adults with hypertension.”

According to the researchers, girls, older adolescents, and those who did not have EKGs or renal ultrasonography were less likely to receive echocardiogram than boys, younger adolescents, those who had EKGs and those who had renal ultrasonography.

They highlight that the he patterns of EKG and echocardiogram use in their study raises questions “about the level of familiarity, awareness or agreement with pediatric hypertension guideline recommendations and the rationale behind these recommendations.”

The researchers conclude:

“The decision and choice of diagnostic tests to evaluate for target organ damage in adolescents with essential hypertension warrant further study to understand the underlying rationale for those decisions and to determine treatment effectiveness.”

Written by Grace Rattue