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Therapeutic inertia: underdiagnosed and undertreated hypertension in children participating in the T1D Exchange Clinic Registry
Author(s) -
Nambam Bimota,
DuBose Stephanie N,
Nathan Brandon M,
Beck Roy W,
Maahs David M,
Wadwa R Paul,
Tamborlane William V,
Foster Nicole C,
Miller Kellee M,
Haller Michael J
Publication year - 2016
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12231
Subject(s) - medicine , blood pressure , diabetes mellitus , pediatrics , percentile , type 1 diabetes , angiotensin receptor blockers , disease , medical record , ace inhibitor , angiotensin converting enzyme , endocrinology , statistics , mathematics
Abstract Objectives Reduction of cardiovascular risk in children with type 1 diabetes requires aggressive management of hypertension ( HTN ). However, the frequency of diagnosing and effectively treating HTN in youth with type 1 diabetes has not been established. To address this question, we used the data collected in >9000 youth with type 1 diabetes who enrolled in the T1D Exchange Clinic Registry. Research design and methods This analysis included data from medical records of 9362 individuals with enrolment and 1‐yr follow‐up visits (age 3 to <18 yr, disease duration ≥ 1 yr at follow‐up). Data included the prevalence of a documented diagnosis of HTN , elevated blood pressure ( BP ) (systolic or diastolic ≥95th percentile for age, gender, and height), and treatment with angiotensin converting enzyme (ACE)‐receptor inhibitor ( ACE ‐I)/angiotensin receptor blocker ( ARB ) therapy. Results HTN was diagnosed in only 1% (113/9362) of participants; yet, elevated BP was recorded at one of the two visits in 17% and at both visits in 4%. Among those with diagnosed HTN , only 52% (59/113) were receiving ACE ‐I/ ARB therapy and only 32% (19 of 59) of those treated were at goal BP . Children with diagnosed HTN had higher HbA1c (adjusted p < 0.001) and higher BMI (p < 0.001) when compared with children without HTN . Conclusions HTN is likely under diagnosed and undertreated even in pediatric diabetes clinics. The relatively low proportion of hypertensive children receiving ACE ‐I therapy and reaching BP goals probably identifies an important area for improving care in children with type 1 diabetes.