Retrospective analysis of the patients referred to the pediatric nephrology clinic at Cook Children's for evaluation of hypertension

Background/Significant Aims/ Purpose: There is increasing evidence that hypertension and pre-hypertension are becoming more prevalent in the pediatric population and may contribute to premature atherosclerosis and the early development of cardiovascular disease and kidney disease. Higher blood pressure in childhood correlates with higher blood pressure in adulthood and the onset of hypertension in young adulthood. Despite the awareness of this increasing prevalence, pediatric hypertension is often unrecognized. The purpose of this study was to quantify the proportion of patients, referred to pediatric nephrology clinics for hypertension, who first had elevated blood pressure (EBP) ≥1 year prior to referral. Methods: This study was a single center retrospective chart review of patients aged 3-18 years and referred to the outpatient nephrology clinic at Cook Children's for the evaluation of hypertension, pre-hypertension, or EBP between July 1st 2016 and July 1st 2017. We excluded patients referred for diagnoses other than hypertension, patients previously seen by nephrology, and patients lacking appropriate documentation. We examined patients’ numbers of appointments with EBP (systolic and/or diastolic BP ≥95th percentile) prior to referral and the proportion of patients with ≥1 year between EBP and referral to nephrology. Additionally, we examined the source of the appointments with EBP, looking at the clinics from specialty versus primary care. Results: Of the 135 charts reviewed, 46 patients met inclusion criteria. Of these, only 5 (11%) were referred within the first year of documented EBP. The median time to referral in years was 3.54 for the population studied. The median number of visits prior to referral with documented EBP was 5, and 9 (20%) patients had ≥10 visits with EBP prior to referral. Cardiology and neurology had high and low rates of referral, respectively. Conclusion: Hypertension, considered a silent killer, is associated with premature atherosclerosis and early-onset vascular disease manifestations. Early diagnosis and management are crucial, and preventative measures to limit further development should be taken. For the present data, both the duration of time and number of visits from first EBP to referral to nephrology are concerning from a prevention standpoint. Further data acquisition and analysis are required but the awareness on this topic is essential.