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Yield of diagnostic testing in evaluating etiology and end organ effects of pediatric hypertension

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Pediatric Nephrology Aims and scope Submit manuscript

An Editorial Commentary to this article was published on 31 August 2023

Abstract

Background

Current recommendations regarding the utility of diagnostic investigations for pediatric hypertension are based on limited evidence, leading to wide practice variation. The objective of this study was to characterize the cohort of children that may benefit from secondary hypertension workup, and determine the diagnostic yield of investigations.

Methods

This was a single-center, retrospective cohort study of 169 children aged 1–18 years referred between 2000 and 2015, to a tertiary pediatric nephrology center in Canada, for evaluation of hypertension. The number of investigations completed, abnormal findings, and diagnostic findings that helped establish hypertension etiology was determined.

Results

56 children were diagnosed with primary and 72 children with secondary hypertension in the outpatient setting. Secondary hypertension was predominant at all ages except for obese adolescents ≥ 12 years. Half of children with traditional risk factors for primary hypertension, including obesity, were diagnosed with secondary hypertension. Kidney ultrasound had the highest yield of diagnostic results (19.8%), with no difference in yield between age groups (P = 0.19). Lipid profile had a high yield of abnormal results (25.4%) as part of cardiovascular risk assessment but was only abnormal in overweight/obese children. Echocardiogram had a high yield for identification of target-organ effects in hypertensive children (33.3%).

Conclusion

A simplified secondary hypertension workup should be considered for all hypertensive children and adolescents. High yield investigations include a kidney ultrasound, lipid profile for overweight/obese children, and echocardiograms for assessment of target-organ damage. Further testing could be considered based on results of initial investigations for the most cost-effective management.

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Data availability

The dataset from this study are available from the corresponding author upon reasonable request.

References

  1. Song P, Zhang Y, Yu J et al (2019) Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr 173:1154–1163. https://doi.org/10.1001/jamapediatrics.2019.3310

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gupta-Malhotra M, Banker A, Shete S et al (2015) Essential hypertension vs. secondary hypertension among children. Am J Hypertens 28:73–80. https://doi.org/10.1093/ajh/hpu083

    Article  PubMed  Google Scholar 

  3. Wyszyńska T, Cichocka E, Wieteska-Klimczak A et al (1992) A single pediatric center experience with 1025 children with hypertension. Acta Paediatr 81:244–246. https://doi.org/10.1111/j.1651-2227.1992.tb12213.x

    Article  PubMed  Google Scholar 

  4. Flynn JT, Kaelber DC, Baker-Smith CM et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904. https://doi.org/10.1542/peds.2017-1904

    Article  PubMed  Google Scholar 

  5. Wiesen J, Adkins M, Fortune S et al (2008) Evaluation of pediatric patients with mild-to-moderate hypertension: yield of diagnostic testing. Pediatrics 122:e988-993. https://doi.org/10.1542/peds.2008-0365

    Article  PubMed  Google Scholar 

  6. Baracco R, Kapur G, Mattoo T et al (2012) Prediction of primary vs secondary hypertension in children. J Clin Hypertens (Greenwich) 14:316–321. https://doi.org/10.1111/j.1751-7176.2012.00603.x

    Article  PubMed  Google Scholar 

  7. Urbina E, Alpert B, Flynn J et al (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 52:433–451. https://doi.org/10.1161/HYPERTENSIONAHA.108.190329

    Article  CAS  PubMed  Google Scholar 

  8. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576. https://doi.org/10.1542/peds.114.2.S2.555

    Article  Google Scholar 

  9. Flynn JT, Alderman MH (2005) Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 20:961–966. https://doi.org/10.1007/s00467-005-1855-3

    Article  PubMed  Google Scholar 

  10. Gomes RS, Quirino IG, Pereira RM et al (2011) Primary versus secondary hypertension in children followed up at an outpatient tertiary unit. Pediatr Nephrol 26:441–447. https://doi.org/10.1007/s00467-010-1712-x

    Article  PubMed  Google Scholar 

  11. Flynn J, Zhang Y, Solar-Yohay S, Shi V (2012) Clinical and demographic characteristics of children with hypertension. Hypertension 60:1047–1054. https://doi.org/10.1161/HYPERTENSIONAHA.112.197525

    Article  CAS  PubMed  Google Scholar 

  12. Çakıcı EK, Yazılıtaş F, Kurt-Sukur ED et al (2020) Clinical assessment of primary and secondary hypertension in children and adolescents. Arch Pediatr 27:286–291. https://doi.org/10.1016/j.arcped.2020.06.005

    Article  PubMed  Google Scholar 

  13. Kapur G, Ahmed M, Pan C et al (2010) Secondary hypertension in overweight and stage 1 hypertensive children: a Midwest Pediatric Nephrology Consortium report. J Clin Hypertens (Greenwich) 12:34–39. https://doi.org/10.1111/j.1751-7176.2009.00195.x

    Article  PubMed  Google Scholar 

  14. Ahmed M, Eggleston D, Kapur G et al (2008) Dimercaptosuccinic acid (DMSA) renal scan in the evaluation of hypertension in children. Pediatr Nephrol 23:435–438. https://doi.org/10.1007/s00467-007-0656-2

    Article  PubMed  Google Scholar 

  15. Patzer L, Seeman T, Luck C et al (2003) Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122. https://doi.org/10.1067/mpd.2003.13

    Article  PubMed  Google Scholar 

  16. Simoes e Silva AC, Silva JMP, Diniz JSS et al (2007) Risk of hypertension in primary vesicoureteral reflux. Pediatr Nephrol 22:459–462. https://doi.org/10.1007/s00467-006-0349-2

    Article  PubMed  Google Scholar 

  17. Brady TM, Fivush B, Flynn JT, Parekh R (2008) Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr 152(73–78):78.e1. https://doi.org/10.1016/j.jpeds.2007.05.053

    Article  PubMed  Google Scholar 

  18. Stern MP (1995) Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes 44:369–374. https://doi.org/10.2337/diab.44.4.369

    Article  CAS  PubMed  Google Scholar 

  19. Urbina EM, Williams RV, Alpert BS et al (2009) Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension 54:919–950. https://doi.org/10.1161/HYPERTENSIONAHA.109.192639

    Article  CAS  PubMed  Google Scholar 

  20. Martino F, Puddu PE, Pannarale G, Colantoni C, Martino E, Zanoni C, Barillà F (2013) Hypertension in children and adolescents attending a lipid clinic. Eur J Pediatr 172:1573–1579. https://doi.org/10.1007/s00431-013-2082-8

    Article  PubMed  Google Scholar 

  21. Weiss R, Bremer AA, Lustig RH (2013) What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci 1281:123–140. https://doi.org/10.1111/nyas.12030

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Stabouli S, Polderman N, Nelms CL et al (2022) Assessment and management of obesity and metabolic syndrome in children with CKD stages 2–5 on dialysis and after kidney transplantation—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 37:1–20. https://doi.org/10.1007/s00467-021-05148-y

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada

    FangChao Linda Ding, Isaac Elias, Rebecca Wright, Alanna De Mello, Dan Cojocaru & Janis Dionne

  2. Division of Nephrology, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada

    Janis Dionne

Authors
  1. FangChao Linda Ding
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  2. Isaac Elias
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  3. Rebecca Wright
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  4. Alanna De Mello
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  5. Dan Cojocaru
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  6. Janis Dionne
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Contributions

Conceptualization: Isaac Elias, Janis Dionne; Methodology: Isaac Elias, Fangchao Linda Ding, Janis Dionne; Data collection: Isaac Elias, FangChao Linda Ding, Rebecca Wright, Alanna De Mello, Dan Cojocaru; Formal analysis: FangChao Linda Ding, Janis Dionne; Writing—original draft preparation: FangChao Linda Ding; Writing—review and editing: FangChao Linda Ding, Janis Dionne; Supervision: Janis Dionne.

Corresponding author

Correspondence to Janis Dionne.

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Ethics approval

The study was approved by the University of British Columbia Children’s and Women’s Research Ethics Board and was in accordance with The Code of Ethics of the World Medical Association.

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The authors have no relevant financial or non-financial interests to disclose.

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Ding, F.L., Elias, I., Wright, R. et al. Yield of diagnostic testing in evaluating etiology and end organ effects of pediatric hypertension. Pediatr Nephrol 39, 513–519 (2024). https://doi.org/10.1007/s00467-023-06101-x

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  • DOI: https://doi.org/10.1007/s00467-023-06101-x

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