Therapeutic inertia: Underdiagnosed and undertreated hypertension in children participating in the T1D Exchange Clinic Registry

Bimota Nambam, Stephanie N. Dubose, Brandon M. Nathan, Roy W. Beck, David M. Maahs, R. Paul Wadwa, William V. Tamborlane, Nicole C. Foster, Kellee M. Miller, Michael J. Haller

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)15-20
Number of pages6
JournalPediatric Diabetes
Volume17
Issue number1
DOIs
StatePublished - Feb 1 2016

Bibliographical note

Publisher Copyright:
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.

Keywords

  • Complications of diabetes mellitus
  • Diagnosis
  • Hypertension
  • Type 1 diabetes mellitus

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