Abstract
Blood Pressure screening in children and adolescents is currently recommended by several prominent medical organizations, including the American Heart Association, the National High Blood Pressure Education Program, the National Heart, Lung, and Blood Institute, the European Society of Hypertension, and the American Academy of Pediatrics. This practice was recently subject to intense scientific review by the U.S. Preventive Services Task Force. The conclusion of the Task Force was that “current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents.” This commentary provides an alternate interpretation of current evidence for blood pressure screening in children and adolescents and highlights its importance as a part of routine medical care.
Abbreviations
- BP:
-
Blood pressure
- CV:
-
Cardiovascular
- LVH:
-
Left ventricular hypertrophy
- USPSTF:
-
United States Preventive Services Task Force
References
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD 3rd, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA 3rd, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA (2010) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260
Chockalingam A, Campbell NR, Fodor JG (2006) Worldwide epidemic of hypertension. Can J Cardiol 22(7):553–555
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2013) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245
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[2 Suppl 4th Report]:555–576
Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2011) Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121(7):948–954
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(1):73–78
McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T, Sorof JM, Portman R, Sorof JM, Portman RJ, National High Blood Pressure Education Program Working Group (2007) Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension 50(2):392–395
Hill JA, Olson EN (2008) Cardiac plasticity. N Engl J Med 358(13):1370–1380
Bao W, Threefoot SA, Srinivasan SR, Berenson GS (1995) Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens 8(7):657–665
Lauer RM, Clarke WR (1989) Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics 84(4):633–641
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung and Blood Institute (2011) Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128 [Suppl 5]:S213–256
Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 338(23):1650–1656
Zieske AW, Malcom GT, Strong JP (2002) Natural history and risk factors of atherosclerosis in children and youth: the PDAY study. Pediatr Pathol Mol Med 21(2):213–237
Laitinen TT, Pahkala K, Magnussen CG, Viikari JS, Oikonen M, Taittonen L, Mikkilä V, Jokinen E, Hutri-Kähönen N, Laitinen T, Kähönen M, Lehtimäki T, Raitakari OT, Juonala M (2012) Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation 125(16):1971–1978
Hagan J, Shaw J, Duncan P (2008) Bright futures: guidelines for health supervision of infants, children, and adolescents. American Academy of Pediatrics, Elk Grove Village, IL
Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wühl E, Zanchetti A, European Society of Hypertension (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27(9):1719–1742
Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K (2003) American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 107(11):1562–1566
Moyer VA (2013) Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force Recommendation Statement. Pediatrics 132(5):907–914
Tschumi S, Noti S, Bucher BS, Simonetti GD (2011) Is childhood blood pressure higher before or after clinic consultation? Acta Paediatr 100(5):775–777
Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ (2004) Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 113(3 Pt 1):475–482
Redwine KM, Acosta AA, Poffenbarger T, Portman RJ, Samuels J (2011) Development of hypertension in adolescents with pre-hypertension. J Pediatr 160(1):98–103
U.S. Census Bureau (2011) Annual estimates of the resident population by sex and five-year age groups for the United States: April 1, 2000 to July 1, 2009 (NC-EST2009-01). In: US Census Bureau (ed) Statistical Abstract of the United States: 2012. U.S. Census Bureau, Suitland
Shapiro DJ, Hersh AL, Cabana MD, Sutherland SM, Patel AI (2012) Hypertension screening during ambulatory pediatric visits in the United States, 2000–2009. Pediatrics 130(4):604–610
Brady TM, Solomon BS, Neu AM, Siberry GK, Parekh RS (2010) Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children. Pediatrics 125(6):e1286–e1293
Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298(8):874–879
Rosner B, Cook N, Portman R, Daniels S, Falkner B (2008) Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am J Epidemiol 167(6):653–666
Flynn JT (2011) Management of hypertension in the young: role of antihypertensive medications. J Cardiovasc Pharmacol 58(2):111–120
Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Janas R, Wawer ZT, Wisniewski A, Feber J (2010) Regression of target organ damage in children and adolescents with primary hypertension. Pediatr Nephrol 25(12):2489–2499
Seeman T, Gilik J, Vondrak K, Simkova E, Flogelova H, Hladikova M, Janda J (2007) Regression of left-ventricular hypertrophy in children and adolescents with hypertension during ramipril monotherapy. Am J Hypertens 20(9):990–996
Lande MB, Adams HR, Kupferman JC, Hooper SR, Szilagyi PG, Batisky DL (2013) A multicenter study of neurocognition in children with hypertension: methods, challenges, and solutions. J Am Soc Hypertens 7(5):353–362
Grover S, Coupal L, Lowensteyn I (2008) Preventing cardiovascular disease among Canadians: is the treatment of hypertension or dyslipidemia cost-effective? Can J Cardiol 24(12):891–898
Flynn JT (2001) Evaluation and management of hypertension in childhood. Prog Pediatr Cardiol 12(2):177–188
Acknowledgments
The authors would like to thank the members of the American Society of Pediatric Nephrology Council for their input and endorsement of this commentary.
Sources of Funding
None.
Author information
Authors and Affiliations
Consortia
Corresponding author
Rights and permissions
About this article
Cite this article
Brady, T.M., Redwine, K.M., Flynn, J.T. et al. Screening blood pressure measurement in children: are we saving lives?. Pediatr Nephrol 29, 947–950 (2014). https://doi.org/10.1007/s00467-013-2715-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-013-2715-1