Therapeutic inertia: underdiagnosed and undertreated hypertension in children participating in the T1D Exchange Clinic Registry

Pediatr Diabetes. 2016 Feb;17(1):15-20. doi: 10.1111/pedi.12231. Epub 2014 Oct 21.


Objectives: Reduction of cardiovascular risk in children with type 1 diabetes requires aggressive management of hypertension (HTN). However, the frequency of diagnosing and effectively treating HTN in youth with type 1 diabetes has not been established. To address this question, we used the data collected in >9000 youth with type 1 diabetes who enrolled in the T1D Exchange Clinic Registry.

Research design and methods: This analysis included data from medical records of 9362 individuals with enrolment and 1-yr follow-up visits (age 3 to <18 yr, disease duration ≥ 1 yr at follow-up). Data included the prevalence of a documented diagnosis of HTN, elevated blood pressure (BP) (systolic or diastolic ≥95th percentile for age, gender, and height), and treatment with angiotensin converting enzyme (ACE)-receptor inhibitor (ACE-I)/angiotensin receptor blocker (ARB) therapy.

Results: HTN was diagnosed in only 1% (113/9362) of participants; yet, elevated BP was recorded at one of the two visits in 17% and at both visits in 4%. Among those with diagnosed HTN, only 52% (59/113) were receiving ACE-I/ARB therapy and only 32% (19 of 59) of those treated were at goal BP. Children with diagnosed HTN had higher HbA1c (adjusted p < 0.001) and higher BMI (p < 0.001) when compared with children without HTN.

Conclusions: HTN is likely under diagnosed and undertreated even in pediatric diabetes clinics. The relatively low proportion of hypertensive children receiving ACE-I therapy and reaching BP goals probably identifies an important area for improving care in children with type 1 diabetes.

Keywords: complications of diabetes mellitus; diagnosis; hypertension; type 1 diabetes mellitus.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / physiology*
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / complications*
  • Diagnostic Techniques, Cardiovascular*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Male
  • Prognosis
  • Registries*
  • Retrospective Studies
  • Risk Factors
  • Time Factors


  • Antihypertensive Agents