Ladies' Home Journal's 3rd Annual Health Breakthrough Awards

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David C. Kaelber, MD, PhD: Finding High Blood Pressure in Children

Most of us know the reading that indicates an adult has high blood pressure: anything greater than 140/90. But until recently even doctors haven't given much thought to high blood pressure in children. When they have, it's complicated by age, gender, and height. A score considered normal for one 7- or 11-year-old may be considered high in another. Doctors have reference tables to consult, but wading through them can prove cumbersome. Diagnosis is further complicated because three abnormal readings over three doctor's visits are needed for a diagnosis, during which time a child will get older and height may have changed.

David C. Kaelber, MD, PhD, an internist and pediatrician at MetroHealth System, in Cleveland, has figured out how to get around these problems and has identified, for the first time, that high blood pressure is an undiagnosed chronic disease in children. According to his findings, published last August in the Journal of the American Medical Association, as many as 1.5 million American children may have undetected hypertension, a disorder in itself that can also be a sign of illnesses such as kidney or heart disease.

His new diagnostic tool is a computer software program, similar versions of which may soon be available to doctors treating kids everywhere. Using MetroHealth's electronic medical records (EMR) database, Dr. Kaelber's program evaluates a child's blood pressure reading, factors in gender, age, and height, and quickly determines whether it is normal or not. Dr. Kaelber discovered the high rate of undiagnosed high blood pressure by evaluating the 14,000 children whose records were already in MetroHealth's EMR database and extrapolating it.

This fall the American Academy of Pediatrics' (AAP) Information Technology Council will sponsor an EMR documentation challenge. Identifying elevated blood pressure will be one of the required tasks for EMR vendors who participate. Council members believe Dr. Kaelber's study helped demonstrate how available EMRs can be -- and helped raise awareness of hypertension as a significant health problem among children.

The idea for the study occurred to Dr. Kaelber, 39 and the father of a young daughter, in 2005, when as a medical director for a pediatric weight-management program he often had to tell parents that their child was hypertensive. "Usually parents would say, 'I didn't even know children could have high blood pressure,'" he recalls. "Then their reaction would quickly change to: 'Wait a minute. How come you're the first to tell me my child has hypertension?'"

"It is an extraordinarily important study," says pediatrician Eugenia Marcus, MD, of Pediatric Health Care at Newton Wellesley, in Massachusetts, and vice-chair of the Council on Clinical Information Technology of the AAP. "It can help doctors better recognize abnormalities and intervene before they develop into major disease." Following Dr. Kaelber's discovery the Certification Commission for Health Information Technology (CCHIT), which writes EMR standards, will require the ability to analyze a child's blood pressure for CCHIT certification starting this month, adds Dr. Marcus, who serves on the group's child-health panel.

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