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USPSTF: Evidence on hypertension screening for asymptomatic children inconclusive
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There is insufficient evidence to assess the benefits and harms of primary hypertension screening for asymptomatic children and adolescents, according to a statement from the United States Preventive Services Task Force.
The task force reviewed new evidence since its last recommendation in 2003. The review included studies on the screening and diagnostic accuracy of BP tests for children and adolescents, effectiveness and harms of treatment of screen-detected hypertension in children and the association of hypertension with markers for CVD, both in childhood and adulthood.
The prevalence of hypertension in US children and adolescents is estimated to be 1% to 5% overall and 11% for obese children and adolescents, Virginia A. Moyer, MD, MPH, and colleagues wrote in the statement.
A potential benefit of screening for hypertension in asymptomatic youth “is that early identification of primary hypertension could lead to interventions to reduce [BP] during childhood and adolescence, resulting in a reduced risk for cardiovascular events and death in adulthood,” the task force wrote.
However, the task force found no direct evidence that routine BP measurement accurately identifies children and adolescents who are at increased risk for CVD or hypertension as adults. While people with hypertension as children or adolescents are more likely to have the condition as an adult, the studies reviewed by the task force showed that predictive values of childhood hypertension for adult hypertension range from poor (19%) to modest (65%), and sensitivity (0 to 0.66) and specificity (0.77 to 1) varied widely. Many of those studies included confounding factors such as kidney disease. Also, the studies used different definitions of childhood and adult hypertension, according to the task force.
Further, the review revealed no adequate evidence to support the hypothesis that treatment of elevated BP in children results in decreased BP because studies conducted on that topic were of very short duration.
The task force also did not find enough evidence to assess the harms of BP screening in children and adolescents. Only one good-quality study was identified, and it did not find drawbacks of detecting hypertension in childhood. The task force also did not find enough evidence to assess the harms of treatment for elevated childhood BP, as adverse event rates were often not reported completely and follow-up tended to be short.
The American Heart Association, American Academy of Pediatrics and other organizations recommend that children be screened for elevated BP during annual well-child visits beginning at age 3 years.
For more information:
Moyer VA. Ann Intern Med. 2013;doi:10.7326/0003-4819-159-9-201311050-00725.
Disclosure: The task force members report no relevant financial disclosures.