Findings suggest children with normal BP may not need yearly screenings

Key takeaways:

• Children and teens with elevated BP were twice as likely to have high BP as adults.
• The probabilities for maintaining normal BP from childhood to adolescence were 0.64 for boys and 0.81 for girls.

Children with normal blood pressure may not need BP screenings as often as current recommendations call for, according to a longitudinal study published in JAMA Pediatrics.

The AAP released guidelines in 2017 recommending BP screening at annual well-child visits. However, the U.S. Preventative Services Task Force published a statement in 2020 arguing that there is insufficient evidence to recommend BP screening in children, and that providers should use their best judgement.

“The associations of pediatric BP with preclinical and clinical cardiovascular outcomes in adulthood have been established form long-term observational studies,” Yaxing Meng, PhD, researcher at the Baker Heart and Diabetes Institute at the University of Melbourne in Australia, and colleagues wrote. “However, no studies have directly tested the hypothesis that achieving and maintaining normal BP earlier in life could delay or even prevent the onset of hypertension and related cardiovascular complications.”

The prospective study followed 2,918 participants (53.2% women; mean age at baseline, 10.7 years; standard deviation, 5 years) in Finland from 1980 to 2018. In 1980, the researchers recruited children and adolescents and tracked their BP nine times over nearly 40 years to look for trends in childhood, adolescence and adulthood. Mean follow-up was 33.4 (standard deviation, 7.6) years.

Overall, children and adolescents with high BP were 2.16 times more likely to have elevated BP as adults (95% CI, 1.95-2.39). The researchers found that more severe hypertension in childhood and adolescence increased the odds for having hypertension in adulthood.

Women with normal BP when they were young were less likely to develop hypertension as adults compared with men. Additionally, women with hypertension in childhood had higher odds for reverting to normal BP than men, Meng and colleagues wrote.

For young adults with normal BP, the transition probabilities for developing elevated BP or hypertension were 0.58 for men and 0.31 for women.

Among all participants, the odds for having normal BP as adults were higher for those who had hypertension in childhood (transition probability range, 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66) vs. adolescence (transition probability range, 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48).

The transition probabilities for maintaining normal BP from childhood to adolescence were 0.64 (95% CI, 0.6-0.67) for boys and 0.81 (95% CI, 0.79-0.84) for girls.

“These findings suggest that children with normotensive readings might not require as frequent BP screening as currently advised,” Meng and colleagues wrote. “Although our research does not explicitly endorse or oppose pediatric BP screening programs, the insights provided could inform screening strategies in pediatric care.”