Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease
ABSTRACT The prevalence of hypertension is increasing in children, and may persist into adulthood. This systematic review was conducted for the US Preventive Services Task Force recommendation on the effectiveness of screening asymptomatic children and adolescents for hypertension in order to prevent cardiovascular disease.
Eligible studies were identified from Medline and the Cochrane Library (through July 2012). We included trials and controlled observational studies in asymptomatic children and adolescents on the effectiveness and harms of screening and treatment, as well as accuracy of blood pressure measurement. One author extracted study characteristics and results, which were checked for accuracy by a second author.
No studies evaluated the effects of screening for hypertension on health outcomes. Two studies of screening tests for elevated blood pressure reported moderate sensitivities (0.65, 0.72) and specificities (0.75, 0.92). Sensitivities and specificities of child hypertension for the later presence of adult hypertension (7 studies) were wide ranging (0-0.63 and 0.77-1.0, respectively), and associations between child hypertension and carotid intima media thickening and proteinuria in young adults (3 studies) were inconsistent. Seven studies reported that drug interventions effectively lowered blood pressure in adolescents over short follow-up periods. No serious treatment-related adverse effects were reported.
There is no direct evidence that screening for hypertension in children and adolescents reduces adverse cardiovascular outcomes in adults. Additional studies are needed to improve diagnosis and risk stratification of children with elevated blood pressure and to quantify risks and benefits of interventions.
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ABSTRACT: AbstractObjective In adults with arterial hypertension, measuring arterial stiffness by pulse wave velocity (PWV) can determine the extent of cardiovascular subclinical organ damage. PWV has independent predictive value for cardiovascular events, but there are currently no recommendations for measuring PWV in children. In addition, central systolic blood pressure (cSBP) strongly reflects vascular changes. The aim of this study was to establish percentiles for cSBP and PWV in children and adolescents to evaluate and classify altered vascular function in youths. Methods and Results We measured PWV and cSBP with an oscillometric device with inbuilt ARCSolver-algorithm (estimated by using the brachial waveform) and calculated smoothed reference percentiles for 1445 children and young adults (49.5% female;13.41±2.80 years, range 8-22 years; PWV 4.67±0.34 m/s; cSBP 100.7±8.9 mmHg) using the LMS-method based on age and height. PWV and cSBP increased with age and height, but slightly differently for girls and boys, possibly reflecting different growth patterns. Between 8-21 years, PWV increased from 4.29±0.32 to 4.98±0.33 m/s in girls and from 4.27±0.18 to 5.22±0.46 m/s in boys; while, girls showed a minor increase in cSBP (91.2±7.5 to 109.1±8.6 mmHg). The cSBP in boys ranged from 90.0±5.8 to 110.5±9.6 mmHg with a more pronounced increase between 14-17 years. Conclusion These percentiles for PWV and cSBP can help define arterial stiffness in youths and contribute to risk stratification for cardiovascular disease. For example, in children with prehypertension or isolated systolic hypertension, PWV and cSBP can provide additional information about the function of the vascular system, thereby strengthening intervention strategies.Atherosclerosis 01/2015; 238(1-1):9-16. DOI:10.1016/j.atherosclerosis.2014.11.005 · 3.97 Impact Factor
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ABSTRACT: Importance: Several studies have reported high prevalence of risk factors for cardiovascular disease in adolescents. Objectives: To perform: i) systematically review the literature on the prevalence of high blood pressure (HBP) in adolescents; ii) analyse the possible methodological factors associated with HBP; and iii) compare the prevalence between developed and developing countries. Data Sources: We revised 10 electronic databases up to August 11st, 2013. Review Methods: Only original articles using international diagnosis of HBP were considered. The pooled prevalence's of HBP were estimated by random effects. Metaregression analysis was used to identify the sources of heterogeneity across studies. Results: Fifty-five studies met the inclusion criteria and total of 122,053 adolescents included. The pooled-prevalence of HBP was 11.2%; 13% for boys and 9.6% for girls (p<0.01). Method of measurement of BP and year in which the survey was conducted were associated with heterogeneity in the estimates of HBP among boys. Conclusion: The data indicate that HBP is higher among boys than girls, and that the method of measurement plays an important role in the overall heterogeneity of HBP value distributions, particularly in boys.Medicine 10/2014; DOI:10.1097/MD.0000000000000232 · 4.87 Impact Factor
Journal of Clinical Hypertension 11/2014; DOI:10.1111/jch.12444 · 2.96 Impact Factor