Diagnostic Ultrasound and ECG Screening in Adolescents with Hypertension Infrequently Utilized

A study of adolescents with hypertension enrolled in a US Medicaid program suggests that guideline-recommended diagnostic tests--renal ultrasonography and echocardiograms (ECGs)--were infrequently used.

The study’s findings were published online July 2012 by Archives of Pediatrics & Adolescent Medicine, a Journal of the American Association (JAMA) Network publication. Hypertension is a growing problem for adolescents because of the association between obesity and hypertension. Current pediatric guidelines recommend laboratory tests and renal ultrasonography for all pediatric patients with hypertension to rule out renal (kidney) disease. The guidelines also recommend echocardiograms to assess target organ damage. But little is known about echocardiogram use among adolescents in comparison with other recommended diagnostic tests (renal ultrasonography) and nonrecommended, but more readily available tests, such as electrocardiograms (ECGs), according to the study’s findings.

Esther Y. Yoon, MD, MPH, and colleagues of the University of Michigan (Ann Arbor, USA) studied ECG use in adolescents and compared it with ECG and renal ultrasonography use in an analysis of administrative claims data from the Michigan Medicaid program from 2003 to 2008. There were 951 adolescents with “essential” hypertension (i.e., the cause is unknown) who had antihypertensive pharmacy claims: 24% (226) had ECGs; 22% (207) had renal ultrasonography; and 50% (478) had ECGs, the results indicate.

“Our study describes for the first time, to our knowledge, equally low levels of obtaining echocardiograms and renal ultrasonography, which are recommended by national hypertension guidelines, by adolescents with essential hypertension,” the authors noted. “In contrast, we found that one-half of adolescents with essential hypertension had at least one ECG during the study period, a diagnostic test that is not recommended by pediatric hypertension guidelines, but one that is recommended for adults with hypertension.”

Boys, younger adolescents, those who had ECGs and those who had renal ultrasonography were more likely to receive echocardiograms compared with girls, older adolescents, and those who did not have ECGs or renal ultrasonography. The authors suggested that the patterns of ECG and echocardiogram use in their study raises questions “about the level of familiarity, awareness, or agreement with pediatric hypertension guideline recommendations and the rationale behind these recommendations.”

“The decision and choice of diagnostic tests to evaluate for target organ damage in adolescents with essential hypertension warrant further study to understand the underlying rationale for those decisions and to determine treatment effectiveness,” the researchers concluded.

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