Alarming Increase in Hypertension in US Children

June 19, 2012

June 19, 2012 (Ann Arbor, Michigan)— The first comprehensive look at inpatient treatment for pediatric hypertension in the US over a period of 10 years, from 1997 to 2006, shows that hospitalizations for this indication almost doubled over the course of the study, and associated costs also rocketed [1]. The report was published online June 18, 2012 in Hypertension.

Lead author Dr Cheryl L Tran (University of Michigan, Ann Arbor), a pediatric nephrologist, told heartwire the figures were "surprising and alarming. The take-home message is that the frequency of pediatric hypertension hospitalization is rising and the fraction of charges attributed to hypertension is increasing."

The frequency of pediatric hypertension hospitalization is rising, and the fraction of charges attributed to hypertension is increasing; this is surprising and alarming.

In an accompanying editorial [2], Dr Joshua Samuels (University of Texas Health Science Center at Houston Medical School) says Tran et al "have provided the first glimpse of the growing economic impact that hypertension in children is playing. This important study helps dispel some of the remaining myths about pediatric high blood pressure. The biggest myth is that hypertension is an adult disease with no real relevance to children."

Both Tran and colleagues and Samuels believe obesity to be one of the main underlying factors driving this rise in hypertension among children. "These significant increases in blood pressure are likely riding the wave of pediatric obesity that is spreading across America," comments Samuels.

Inpatient Charges for Pediatric Hypertension Are $3 Billion Over 10 Years

For their study, Tran and colleagues obtained discharge records from the US Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KIP) from 1997, 2000, 2003, and 2006.

They found pediatric hypertension-related hospitalizations nationwide nearly doubled, from 12 661 in 1997 to 24 602 in 2006. Charges for inpatient care for hypertensive children increased by 50%, to an estimated $3.1 billion over the 10 years. This does not include outpatient charges, a figure that remains unknown.

The researchers say that children with hypertension in the inpatient setting are likely to have either severe hypertension or hypertension that complicates a coexisting condition. In fact, they demonstrated that hospitalization of children with hypertension and end-stage kidney disease, for example, results in significant increases in healthcare charges, and the average length of stay for children with hypertension was double that of children with other illnesses, eight days compared with four.

"We were definitely surprised with the rise in frequency of hypertension in the hospital setting," Tran told heartwire , although she notes that previous studies have shown a rise in pediatric high blood pressure in the outpatient setting, so "this may be a reflection of that."

She and her colleagues also examined demographic data to see whether they could identify a certain population at higher risk. "We found that children hospitalized with hypertension were more likely to be male, older than nine, African American, and treated in a teaching hospital," she notes.

When the researchers looked at hypertension as the primary diagnosis, they found that obesity was one of the most common secondary diagnoses. But Tran says the analysis is in part limited by the fact that a claims database was employed, using discharge data, "and obesity, because it is not typically reimbursable, is often not charted as a diagnosis." Nevertheless, the findings bring to the fore the question of how pediatric hypertension may be prevented, she says.

"Having healthcare providers continue to counsel families--providing education on healthy lifestyles such as diet and exercise--but also making sure that we are identifying hypertension in children early on to ensure we are providing appropriate therapy" are all key, Tran says. "These two things are the first steps toward helping to prevent the disease and/or associated complications."

Debunking the Myths of High BP in Kids; "We Cannot Afford to Wait"

Samuels agrees, debunking what he says are a number of other falsehoods about pediatric hypertension and noting that therapy options now include antihypertensive agents for children.

One myth is that pediatric hypertension is mostly attributed to secondary causes, he says, whereas in reality, "the growing prevalence of obesity [means] the most common diagnosis is essential hypertension." It is also not true that childhood BP is unrelated to adult hypertension--"multiple studies have demonstrated tracking of hypertension into adulthood"--or that children may be diagnosed with hypertension but that true end-organ damage does not occur until adulthood.

"Up to 30% of children diagnosed with hypertension already have evidence of vascular injury, including left ventricular hypertrophy," Samuels asserts.

Up to 30% of children diagnosed with hypertension already have evidence of vascular injury.

And "the current study begins to dispel the final myth," he says, "that pediatric hypertension is only an outpatient finding with little hospital morbidity and cost."

Given the "staggering" cost of hypertension, "now is the time to invest in early detection, prevention, and treatment of elevated BP in children," he comments, noting that pediatricians now have "an array of pharmacological interventions with pediatric dosing, safety, and often even labeling. If the current study tells us anything, it is that we cannot afford to wait," he concludes.

Tran et al report no disclosures. Samuels has no disclosures.

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