Clinical Scorecard: Assessing Pediatric Hypertension Through Observational Data: A Comparison of Clinical and Claims-Based Cohorts in Real-World Settings

At a Glance

Key Highlights

• Clinical definitions identified 9% of children and 8.7% of teens as hypertensive, while claims-based definitions identified fewer patients with hypertension claims.
• Claims-based hypertension patients showed greater disease severity and higher all-cause mortality compared to clinically identified patients.
• There is poor overlap between clinical and claims-based identification methods, indicating under-capture of pediatric hypertension in claims data.

Guideline-Based Recommendations

Diagnosis

• Use clinical blood pressure measurements aligned with 2017 American Academy of Pediatrics guidelines for pediatric hypertension identification.
• Require at least three blood pressure measurements over 36 months for clinical diagnosis.
• Be cautious interpreting claims-based hypertension diagnoses due to under-capture and coding variability.

Management

• Recognize that claims-based hypertension may indicate more severe disease requiring closer clinical attention.
• Leverage electronic health records to improve identification and management of pediatric hypertension.

Monitoring & Follow-up

• Follow patients longitudinally for up to three years to assess blood pressure trends and outcomes.
• Monitor for comorbid conditions associated with pediatric hypertension, including cardiovascular and renal risks.

Risks

• Pediatric hypertension is a predictor of adult systemic hypertension and associated cardiovascular morbidity and mortality.
• Racial and ethnic disparities exist, with Black children at higher risk for elevated blood pressure.

Patient & Prescribing Data

Pediatric patients aged 3 to 17 years identified with hypertension via clinical or claims data

Claims-based hypertension patients may represent more severe disease and could require more intensive management; however, claims data under-capture many clinically hypertensive patients.

Clinical Best Practices

• Utilize both clinical blood pressure measurements and claims data to comprehensively identify pediatric hypertension.
• Understand limitations and coding practices of claims data when selecting real-world data sources for research or clinical decision-making.
• Incorporate electronic health record data to augment identification and monitoring of pediatric hypertension.
• Consider demographic and baseline profile differences when interpreting data from clinical versus claims-based cohorts.

References

• American Academy of Pediatrics 2017 Hypertension Guidelines
• FDA Sentinel System Overview
• Kaelber et al. Pediatric Hypertension Identification Method