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CMAJ Open. 2016 May 5;4(2):E230-5. doi: 10.9778/cmajo.20150016. eCollection 2016 Apr-Jun.

Hypertension screening and follow-up in children and adolescents in a Canadian primary care population sample: a retrospective cohort studystudy.

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University of Toronto Practice Based Research Network (Aliarzadeh, Meaney, Moineddin, White, Greiver), Department of Family Medicine at University of Toronto (Meaney, Moineddin, White, Greiver), The Hospital for Sick Children, Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Parkin, Birken), University of Toronto, Department of Paediatrics (Parkin, Birken), Toronto, Ont.



Uncertainty exists about the need to screen for hypertension in children and adolescents. Information on current screening and follow-up rates in Canadian community practices is not available. There are no Canadian guidelines on the subject. We sought to identify current rates of pediatric hypertension screening and follow-up in Canada. In addition, we examined patient and provider characteristics associated with rates of blood pressure screening.


We used electronic medical record data extracted on Apr. 1, 2013, from 79 family practices in Toronto. We identified children seen at least twice between the ages of 3 and 18 years, with at least 6 months between first and last encounter. We used Multivariate Poisson regression analysis to analyze variation in blood pressure measurement rates and associations with patient and physician factors.


We identified 5996 children (62% of 9667 in total) who had at least 1 blood pressure measurement recorded. Of these children, 14% had at least 1 abnormal blood pressure measurement, and of those children, only 5% had a follow-up measurement recorded within 6 months. After adjustment, increases in rates of blood pressure measurements were associated with greater number of encounters (rate ratio [RR] = 1.03, 95% confidence interval [CI] 1.02-1.04, p < 0.001), older age at first encounter (RR = 1.06, 95% CI 1.03-1.10, p = 0.002), and female sex (RR = 1.12, 95% CI 1.03-1.20, p = 0.006). Obesity or a recorded family history of hypertension were not associated with more blood pressure measurements. Female physicians recorded more blood pressure measurements than did male physicians (RR = 1.41, 95% CI 1.04-1.89, p = 0.02).


This screening measure was frequently done and appeared to be incompletely followed up. Clear guidance is needed; guideline developers should consider reviewing this topic.

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