Evidence map›Paper›PMID 25621304›Full record

ArticleAnnals of pediatrics & child health

Underlying Rationale and Approach to Treat Hypertension in Adolescents by Physicians of Different Specialty.

Esther Y Yoon, Julie S Weber, Brigitte McCool, Albert Rocchini, David Kershaw, Gary Freed, Frank Ascione, Sarah Clark

Open access · greenAbstract read
PubMed Full text at PMC
In one paragraph

Article in Annals of pediatrics & child health. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.2field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Esther Y YoonDivision of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, USA.
Julie S WeberDivision of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, USA ; Wayne State University School of Medicine, USA.
Brigitte McCoolDivision of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, USA.
Albert RocchiniDivision of Pediatric Cardiology, University of Michigan, USA.
David KershawDivision of Pediatric Nephrology, University of Michigan, USA.
Gary FreedDivision of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, USA.
Frank AscioneSchool of Pharmacy, University of Michigan, USA.
Sarah ClarkDivision of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, USA.
University of Michigan–Ann Arbor · US

Funding

Variation in Antihypertensive Prescribing Patterns in ChildrenK23HL092060 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI YOON, ESTHER YOUNGAE · 2009 to 2013
$689k
NHLBI NIH HHS K23 HL092060
6 · The paper itself

Abstract

objectiveTo describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with hypertension.

methodsWe conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each participant was asked to "think aloud" regarding their approach to a hypothetical patient - 12 year old boy with persistent hypertension for 6 months. Standardized open-ended questions about potential factors that could affect physicians' diagnosis and treatment strategies (e.g., patient age) were used. Interviews were audio-recorded; transcribed verbatim; transcripts were independently coded by 2 investigators; emergent themes identified and inter-coder agreement achieved. Thematic analysis was performed based on grounded theory.

resultsNineteen participants included 5 general pediatricians, 5 pediatric cardiologists, 5 pediatric nephrologists and 4 family physicians. Five themes emerged: 1) Accuracy of blood pressure measurement and hypertension diagnosis, 2) Shift in the epidemiology of pediatric hypertension from secondary to primary hypertension, 3) Patient characteristics considered in the decision to initiate workup, 4) Obesity-centered choice of diagnostic tests and lifestyle modifications, and 5) Variable threshold for initiating antihypertensive pharmacotherapy vs. referral to hypertension specialists.

conclusionsThere is variation across primary care and specialty physicians who provide care for children and adolescents with hypertension. Key areas of variability include the willingness to initiate antihypertensive medications, the use of diagnostic tests (e.g., ambulatory blood pressure monitoring), and the perceived need for specialty referral. Further study is needed to assess whether different treatment paradigms result in differential patient outcomes.

Indexed as

AdolescentsClinical decision-makingHypertensionHypertension specialistsPrimary care physiciansSpecialty differences

Identifiers

PMID25621304
PMCPMC4300960
OpenAlexW2345408159

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.