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G418(P) A survey of paediatric blood pressure measurement and management in primary care
  1. LA Plumb,
  2. M Hamilton-Ayres
  1. Children’s Centre, Department of Women and Children’s Health, Gloucestershire Royal Hospital, Gloucester, UK

Abstract

Introduction Childhood hypertension is increasing in prevalence. There is growing evidence to suggest this ‘at risk’ population demonstrate tracking of blood pressure (BP) values into adulthood, and are at risk of end-organ damage manifest at an early age. While there are European recommendations supporting routine monitoring of BP in children from the age of 3 years, in reality this does not occur. As secondary care professionals we are increasingly reliant on General Practitioners (GPs) not only for BP monitoring as part of health promotion but as follow-up in specific circumstances, such in the case of a patient with Henoch-SchÖnlein Purpura. The aim of this survey was to explore the availability of childhood BP resources and understanding of paediatric BP interpretation amongst GPs within the region.

Methods We conducted an online survey (www.surveymonkey.co.uk) for GPs within our region and sent it via email in March 2013.

Results We obtained 100 replies from practitioners across the region, of which 87% were partners. Most GPs (78%) would never routinely measure a child’s blood pressure in a primary care setting, while only 1% would routinely do so from the age of 3 years. Seventy percent of GPs had at least one paediatric cuff while 28% had only an adult-sized cuff available. Over three-quarters (78%) of GPs used a manual sphygmomanometer or oscillometric device as recommended by European hypertension society guidelines. When asked how to size an appropriate cuff, 15% responded correctly while 16% relied on manufacturer markings. A further 41% were unsure, guessed or omitted the question. Seventy-one percent of practitioners would appropriately refer to secondary care after three abnormal readings, or would request ambulatory blood pressure monitoring.

Conclusion Our results demonstrate that resources for paediatric BP measurement are limited in primary care and that routine measurement is often not considered until children are closer to adult age. Appropriate device use and understanding of when to refer however is reassuring. We have found a need for clearer guidance surrounding the use of routine BP monitoring in children, perhaps with clearer communication as to how ‘at risk’ children can be successfully managed between secondary and primary care

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