USPSTF: Insufficient evidence for high BP screening in children, adolescents
Click Here to Manage Email Alerts
A draft recommendation from the U.S. Preventive Services Task Force stated there is insufficient evidence of benefits or harms to support screening for high BP in asymptomatic children and adolescents.
“We identified no direct evidence that compared screening with no screening in asymptomatic children and adolescents,” Gerald Gartlehner, MD, MPH, director of the department for evidence-based medicine and clinical epidemiology at Danube University, Austria, and colleagues wrote in a systematic review from the RTI International-University of North Carolina Evidence-based Practice Center commissioned by the USPSTF. “Epidemiological studies indicate an association between hypertension in childhood and adolescence and hypertension in adulthood. Large longitudinal cohort studies also provide evidence that hypertension in adolescents and young adults is associated with end-stage renal disease and mortality from cerebrovascular events during adulthood. The proportion of spontaneous resolution of hypertension in children and the long-term benefits and harms of treatment, however, remain unclear. The evidence is also inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.”
Lack of evidence
There is not enough evidence to prove the accuracy of high BP screening in children and adolescents, according to the draft recommendation.
Among the 42 studies reviewed, none directly evaluated the benefits or harms of screening, assessed whether treatment of abnormal BP before adulthood affects outcomes in adulthood or addressed screening for secondary hypertension in children who were asymptomatic, the authors wrote.
The draft recommendation stated that there currently is no evidence that screening for high BP in children and adolescents delays or reduces adverse health outcomes; however, there is evidence of a longitudinal association between youth high BP and high BP and intermediate outcomes as adults.
Additionally, the task force reported that there is insufficient evidence that links pharmacologic or lifestyle interventions in childhood or adolescence to BP reductions and intermediate or adverse outcomes in adulthood.
Based on conclusions from the systematic review, the USPSTF added that there is insufficient evidence to assess the potential harms of screening children and adolescents for high BP in addition to a lack of evidence for the negative effects of pharmacologic or lifestyle interventions.
The panel recommended that clinicians consider risk factors such as elevated BMI, family history of hypertension, low birth weight, male sex, black race and Hispanic ethnicity when determining screening for high BP in child or adolescent.
Future research
“Given the ethical considerations about withholding a screening intervention that is commonly used in clinical practice, an adequately powered randomized controlled trial or other controlled prospective study that compares long-term health outcomes of screened and unscreened children is unlikely,” the authors wrote. “Future research, therefore, needs to establish a stronger evidence base for intermediate links between screening for hypertension and relevant outcomes during childhood and adulthood. Specifically, it should determine the diagnostic test accuracy of blood pressure measurements with aneroid sphygmomanometers or oscillometric automated devices and establish clear thresholds for hypertension for 24-hour ambulatory monitoring.”
The task force will make official recommendations after considering feedback from the draft recommendations. Comments can be submitted until May 18 at www.uspreventiveservicestaskforce.org/uspstf/public-comments-and-nominations/opportunity-for-public-comment. – by Scott Buzby
References:
U.S. Preventive Services Task Force. www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-recommendation-statement&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020. Accessed April 21, 2020.
U.S. Preventive Services Task Force. www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-evidence-review&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020. Accessed April 21, 2020.
Disclosures: The authors report no relevant financial disclosures.
Collapse
Read more about
Click Here to Manage Email Alerts