Abstract
Universal blood pressure (BP) screening in children and adolescents is questioned in prevention guidelines, while measuring blood pressure in the young in the context of overweight, obesity, or parental hypertension is promoted. This study quantifies with population data the underestimation of elevated blood pressure that would result from limiting BP screening only to those with overweight, obesity, or parental hypertension in the young. Selective screening was simulated with representative national health examination data from Germany (age 3-17, N=14,633, KiGGS0 study 2003-2006; age 18-39, N=1,884, DEGS1 2008-2011 study), with mean of two oscillometric measurements on one occasion; cutoffs for hypertensive BP in children were the 95th percentile using KiGGS percentiles, and for sensitivity analyses Fourth Report percentiles, in adults 140/90 mmHg; childhood overweight and obesity were classified according to the International Obesity Task Force and for adults as BMI ≥25 and ≥30 kg/m2. In 3-17-year-olds, different selective BP screening scenarios were simulated: screening only in those with obesity, overweight, parental hypertension, combination of overweight and parental hypertension, resulting in screening 5.6%, 20.0%, 28.5%, and 42.6% of the population and detecting 17.2%, 38.6%, 30.3%, and 58.2% of all hypertensive cases in the population. In conclusion our results show a large screening gap that would result from selective BP screening only in those with overweight, obesity, or parental hypertension.
Highlights
Blood pressure (BP) screening in children and adolescents is subject to an ongoing debate [1,2,3,4,5,6,7,8] and is recommended in hypertension guidelines [7,8,9] but questioned in prevention guidelines [2, 3]
BP screening in youth with obvious hypertension risk factors such as obesity has been suggested as a reasonable selective screening strategy [4] without reference to the implications of not screening everybody else
In hypothetical selective screening scenarios that consist of measuring BP only in children and young adults with overweight, obesity, or parental hypertension, i.e., at increased risk of hypertension based on available clinical information, the proportion of the population that would be screened corresponds to the prevalence of the selection criterion for screening
Summary
Blood pressure (BP) screening in children and adolescents is subject to an ongoing debate [1,2,3,4,5,6,7,8] and is recommended in hypertension guidelines [7,8,9] but questioned in prevention guidelines [2, 3]. In young adults starting at age 18, universal BP screening is unequivocally recommended [10,11,12]. Hypertension awareness rates in younger adults are rather low compared to older adults [13], suggesting that adherence to universal BP screening may be regarded as less important by the young adults themselves or by their healthcare providers. The aim of our study was to quantify the population wide underestimation of elevated blood pressure resulting from selective blood pressure screening in the young. Data from national health examination surveys in Germany across a wide age-range of 3-39-year-old participants were used to estimate how large the proportion of the population with undetected elevated BP would be if only those with overweight, obesity, or parental hypertension would get their BP measured
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