BP screening: Evidence lacking but problem grows

The jury is still out on whether we should be screening asymptomatic children and adolescents for primary hypertension in an effort to prevent cardiovascular disease later in life, but we do know that being overweight and hypertension are inextricably linked and both problems seem to be growing in children.

The US Preventive Services Task Force (USPSTF) reviewed the literature for the latest evidence on screening for high blood pressure (BP) in childhood and adolescence and for information regarding the accuracy of screening tests used, the pros and cons of treating screen-detected primary childhood hypertension, and the association of childhood hypertension with cardiovascular disease later in life.

The USPSTF found insufficient evidence to recommend for or against screening in asymptomatic children at this time, which means no change in recommendations from its previous statement in 2003. As a result, until further information becomes available, the Task Force recommends that pediatricians make the decision to screen a patient without signs or symptoms of high BP based on a patient’s individual situation, such as whether the child is overweight, which is a strong risk factor.

In fact, a recent population-based study conducted at Kaiser Permanente Southern California’s Department of Research and Evaluation involving almost 250,000 children and adolescents aged between 6 and 17 years found the prevalence of prehypertension and hypertension to be 31.4% and 2.1%, respectively, and that an additional 21.4% had either 1 or 2 BP measurements at or above the 95th percentile.

According Kaiser Permanente, that study found that young people who are overweight are twice as likely as their normal-weight peers to have hypertension; moderately obese children have a 4 times higher risk; and extremely obese children and adolescents are 10 times more likely to have hypertension. That means that approximately 1 in every 10 extremely obese youngsters has hypertension, and nearly half have occasional BP measurements in the hypertensive range.

Many organizations suggest a routine check of BP, at least at annual checkups if not at every health care opportunity, beginning at age 3 years. However many experts argue that no direct evidence exists to show that screening for hypertension in children and adolescents reduces adverse health outcomes or delays the onset of hypertension in adults.

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