Obesity-related hypertension is now diagnosed in children. If undiagnosed and untreated, hypertension increases the likelihood of serious health consequences. To address this problem, we must prepare pediatricians, once focused on anticipatory guidance and disease prevention, to surveil and treat children with overweight and obesity for high blood pressure and hypertension. Because blood-pressure norms in children vary with age, gender, and height, it is difficult to identify three blood-pressure elevations to diagnose hypertension. Our long-term goals are to: 1) identify how to support pediatricians in this major practice paradigm shift, 2) improve delivery of guideline-based weight-management and hypertension care, 3) improve long-term weight management, and 4) reduce morbidity from unrecognized obesity-related disease. Our previous studies revealed: (1) specific guideline-recommended weight management clinical practices are effective, but too-rarely used, (2) providers fail to recognize elevated blood pressures in overweight children, (3) determining pediatric hypertension criteria is a complex, error-prone task, and (4) this impediment to hypertension care can be removed by hypertension clinical decision support. These results led us to ask if we could collate and present to providers information needed to deliver both guideline-based weight management and hypertension care. However, in drafting a potential decision-support system, we confronted age and weight-status variations in screening and evaluation guidelines for weight management and hypertension. This led to our central hypothesis that: (1) expert consensus will resolve conflicts and coordinate guideline-based recommendations for weight management and hypertension care, and (2) application of cognitive-engineering methods currently underused in medicine will enable us to build a single-screen weight- management plus hypertension clinical-decision-support interface that is: (1) easy to use (reduces number of task steps needed), (2) error-resistant (limits number of cognitively demanding steps, including mental calculations and recall), and (3) helpful for efficiently identifying and taking action on key information needed to deliver guideline-based weight-management and hypertension care. Our proposed research will broadly impact the field by transforming the current primary-care weight- management clinical practice paradigm to include guideline-based hypertension care. If successful, the resulting clinical-decision-support model can be applied in the future to address other obesity-related comorbidities. Through future funding, the fully developed tool will be used to test whether weight-management plus hypertension clinical decision support improves weight and blood-pressure control. This work holds great potential to support pediatricians in a major practice paradigm shift and delivery of guideline-based weight management and hypertension care. Delivery of this care holds great potential for reducing future cardiovascular disease in adulthood from unrecognized, untreated obesity and hypertension in children.
Primary-care providers are struggling to identify and treat heart-disease risk factors?present in 60% of overweight children?because they must reference multiple guidelines that lack alignment in screening criteria, laboratory studies, and follow-up intervals recommended. In the proposed project, we will use expert consensus to align weight-management and updated pediatric hypertension guidelines, then develop a single- screen informatics solution that supports pediatricians in identifying and treating hypertension as part of weight management. This research will result in 1) a published consensus document aligning pediatric weight- management and hypertension algorithms, and 2) a drafted informatics solution to support pediatricians in delivering guideline-based weight-management and hypertension care in primary care that we will test through future funding.
