The importance of blood pressure screening in children

Thomas Jefferson University, Department of Medicine and Pediatrics, Philadelphia, Pennsylvania
The Journal of pediatrics (Impact Factor: 3.74). 09/2009; 155(2):299; author reply 299-300. DOI: 10.1016/j.jpeds.2009.03.037
Source: PubMed
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    ABSTRACT: Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.
    01/2013; 167(3):1-8. DOI:10.1001/jamapediatrics.2013.438
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    ABSTRACT: Errors in blood pressure (BP) measurement are common in the clinical practice. Inaccurate measurements of BP may lead to misdiagnosis and inappropriate treatment of hypertension. The preferred method of BP measurement in the clinical setting is auscultation, using the first and the fifth Korotkoff sounds. However, the use of mercury sphygmomanometer is declining. Automated oscillometric devices are an acceptable alternative method of BP measurements if the proper cuff size is used. Aneroid devices are suitable, but they require frequent calibration. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. At 24 h ambulatory monitoring is also useful for diagnosing white-coat hypertension and resistance hypertension. There is increasing evidence that lack of nocturnal BP dipping during the night may be associated with increased cardiovascular event. This report attempts to address the need for accurate BP measurements in children and adolescents by reducing human and equipment errors and providing clinicians with the accurate measurement of BP, which is essential to classify individuals, to ascertain BP-related CV risks and to guide management.
    International journal of preventive medicine 03/2014; 5(Suppl 1):S17-S20.
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    ABSTRACT: Hypertensie komt vaak voor bij kinderen met overgewicht (4-14%) en obesitas (11-24%). Van de kinderen met ernstige obesitas heeft zelfs 50% hypertensie. Hoewel hypertensie meestal symptoomloos verloopt, leidt het tot cardiovasculaire ziekten en nierinsufficiëntie. De jeugdgezondheidszorg in Nederland bereikt 90-95% van de kinderen op verschillende leeftijden en vormt daarmee een unieke setting voor preventie en vroegsignalering van ziekten. Het screenen op hypertensie van kinderen met overgewicht (selectieve preventie) in de jeugdgezondheidszorg om latere cardiovasculaire en nierschade te voorkomen, wordt daarom sinds kort aanbevolen in de JGZ-richtlijn Overgewicht. Dit artikel is een onderbouwing van dit advies. Indien kinderen met overgewicht en obesitas hypertensie hebben, zal in eerste instantie verandering in leefstijl geadviseerd worden: meer bewegen in combinatie met gezonde voeding en een eventuele zoutbeperking. Indien dit beleid onvoldoende succesvol is, zal een antihypertensivum voorgeschreven worden.
    08/2013; 44(4). DOI:10.1007/s12452-012-0020-1