Primary care physicians are missing a significant opportunity to intervene in adolescent health care, the preparticipation sports exam. Study results from North Carolina suggest that physicians widely ignore blood pressure readings that indicate a significant minority of teens are at risk for hypertension.
    "We wanted to know how well we were really doing with preparticipation exams and what things we might do better," said Kevin Burroughs, MD, assistant professor of family medicine at the University of North Carolina at Concord. "For many adolescents, especially males, this is a prime time for intervention. We will not see them in the office on any other occasion unless they are forced to come in by illness or their mothers."
    The primary goal of the preparticipation sports exam is to uncover conditions that would exclude the teen from participating or which would be exacerbated by sports. Most school districts and states across the nation require a preparticipation exam, Dr. Burroughs told the American Academy of Family Physicians Scientific Assembly. And while the exam may be a cursory exercise for some practitioners, it records basic vital signs, including height, weight, and blood pressure.
    UNC researchers examined preparticipation exam records for 1,556 high school and middle school sports participants during the 2003–2004 school year at six different schools. Some of the teens were first-time applicants for sports and others were experienced athletes. Systolic (SBP) and diastolic (DBP) blood pressures recorded for the students were classified according to age- and height-adjusted normative data as designated by the National Heart, Lung and Blood Institute's Working Task Force on Childhood Hypertension.
    The examining physician's final recommendation was reviewed for any mention of an abnormal BP or any recommendation for follow-up. In nearly all cases, Dr. Burroughs said, examining physicians ignored BPs that clearly fall within the WTFCH's range for pre-hypertensive or hypertensive.
    While adult hypertension is classified based on absolute BP, hypertension for children and adolescents is based on norms adjusted by age and height. Individuals at or above the 90th percentile are classified as "pre-hypertensive or hypertensive." Those at or above the 95th percentile are "hypertensive."
    Within the study population, 205 teens (13.3%) showed SBP and 312 (20.2%) showed DBP at or above the 90th percentile. A subgroup of 114 (7.4%) showed SBP and 100 (6.5%) showed DBP at or above the 95th percentile. Forty-six (3%) students hit the 99th percentile for at least one BP measure. But only 14 teens were labeled as abnormal and 11 scheduled for any type of follow-up.
    "One value does not make a hypertensive," Dr. Burroughs noted, "but these are clearly kids we need to go back and follow. Given the reality of teenage life, this may be the only opportunity we have to intervene."
    The problem seems to be two-fold, he said. Some primary care physicians are not aware that hypertension measures for adolescents differ from adult measures. And while the WTFCH publishes charts that allow for direct conversion of age and height to normative values, many physicians do not know the charts exist.
    Dr. Burroughs posited another possible problem: physicians record adolescent BP data without absorbing them.
    "There is absolutely no reason we should not be using blood pressure to evaluate our kids," Dr. Burroughs said. "What it comes down to is that we have to pay attention to the data we are writing down."