Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease

DPhil, Department of Primary Care Health Sciences, Oxford University, New Radcliffe House, Woodstock Road, Oxford OX2 6GG, UK. .
PEDIATRICS (Impact Factor: 5.47). 03/2013; 131(3):490-525. DOI: 10.1542/peds.2012-3523
Source: PubMed


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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Available from: Ian Blazina, Jan 08, 2016
    • "The importance of measuring blood pressure (BP) in childhood and adolescence has been widely recognized [1] [2]; elevated BP in children may be an early sign of essential (or primary) hypertension and childhood BP levels are predictive of adult levels [3] [4]. In Italy, as in other economically developed countries, the prevalence of childhood hypertension has increased in the past years, from 2% to approximately 6% [5]. "
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    ABSTRACT: In Italy, the prevalence of hypertension, obesity and overweight in paediatric patients has increased in the past years. The purpose of this study was to analyse the relationship between obesity and hypertension and related factors in Italian students. We studied 2007 healthy individuals between the ages of 6 and 17 years of age (998 males and 1009 females) attending schools in the cities of Varese (northern Italy), Rome (central Italy) and Catanzaro (southern Italy). The blood pressure, weight and height of the students were measured. We also assessed their daily intake of foods and the amount of physical activity they performed. A questionnaire was administered to the parents of the subjects to obtain information on the child's medical history and family lifestyle. Of the students, 27.2% were overweight, and 6.6% were obese, with the highest percentages in southern Italy. A total of 6.2% of students had hypertension, and the region with the highest percentage was found to be northern Italy. Obese students had a risk of developing hypertension that was four times greater than those subjects who were of normal weight. Overweight and obese children/adolescents were more frequently found in southern Italy as opposed to northern and central Italy, and hypertensive children were more prevalent in the north. An unhealthy diet might explain the more widely spread obesity among children living in the south; an excess use of salt could explain the greater rate of hypertension found among children/adolescents living in the north. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Mar 2015 · Nutrition Metabolism and Cardiovascular Diseases
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    • "The issue of screening has been a contentious discussion in the medical community as of late. The US Preventive Services Task Force (USPSTF) recently published recommendations that do not endorse routine BP measurements in children citing a systematic review that found no direct evidence that screening for hypertension in children and adolescents reduces adverse cardiovascular outcomes in adults[5,6]. The USPSTF report came under extreme scrutiny and criticism by the American Society of Pediatric Nephrology for essentially evaluating an endpoint that has not been "

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  • No preview · Article · May 2013 · American Journal of Hypertension
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