Diagnosis Of Hypertension In Childhood Research Articles

The performance of an integrated model including retinal information in predicting childhood hypertension.

The objective of this study was to examine the association of an integrated model (composed of retinal arteriolar caliber, height, and sex) with blood pressure (BP) among a group of Chinese children, and assess the predictive value of the integrated model for childhood hypertension. This study included 1460 candidates aged 12.634 ± 0.420 years. Height, weight, waist circumference, and BP were obtained and ophthalmological measurements were taken. The computer-imaging program (IVAN, University of Wisconsin, Madison, WI) was used to measure calibers of retinal vessels. Receiver-operating characteristic curve (ROC) analyses were performed to assess the accuracy of the integrated model as a diagnostic test of elevated BP in children. The accuracy of the integrated model (assessed by area under the curve) for identifying elevated BP was 0.777 (95% confidence interval: 0.742-0.812). The optimal threshold of the integrated model for defining hypertension was 0.153, and the calculation formula for the specific predictive risk was: Logit (p/1 - p) = -5.666 - 0.261 × retinal arteriolar caliber + 0.945 × sex + 0.438 × height. In identifying elevated BP, the sensitivity and specificity were 0.711 and 0.736, respectively. The model containing eye message is a comprehensive and relatively effective index to identify elevated BP in 12-year-old children, which can offer assistance to further understand childhood microcirculation disease. We firstly incorporated retinal vascular diameter, sex, and height into one integrated model to identify hypertension in 12-year-old children. The current discrimination of hypertension in children is difficult. There have been some studies to simplify the diagnosis of children's hypertension, but they were limited to anthropometric measurements. We proposed a composed model containing microcirculation information to predict childhood hypertension. Based on the knowledge that microcirculation is not only a means to study the manifestations but also early pathogenic correlates of hypertension, the combined model containing microcirculation message as a method may provide new insights into the diagnosis of childhood hypertension.

Stability of Blood Pressure and Diagnosis of Hypertension in Childhood.

* Abbreviations: AAP — : American Academy of Pediatrics BP — : blood pressure CPG — : Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents Longitudinal tracking studies as well as multiple long-term cohort studies have demonstrated that blood pressure (BP) in childhood tracks into adulthood and that individuals with high BP levels in childhood are more likely to develop intermediate markers of cardiovascular disease by adulthood than those with normal BP.1 What is less well understood is what happens to childhood BP levels over shorter periods of time: weeks, months, or just a few years? This question is relevant to making a diagnosis of hypertension because the 2017 American Academy of Pediatrics (AAP) Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (CPG) recommends repeat BP measurements over a period of weeks to months (depending on how high the BP category) before making a diagnosis of hypertension.2 This recommendation is based on the known lability of childhood BP over short time periods, a point that was established by Ogborn and Crocker over 30 years ago.3 In their study reported in this issue of Pediatrics , … Address correspondence to Joseph T. Flynn, MD, MS, Division of Nephrology, Seattle Children’s Hospital, 4800 Sand Point Way NE, M/S OC.9.820, Seattle, WA 98105. E-mail: joseph.flynn{at}seattlechildrens.org

Prevalence of hypertension and risk factors among school children in Kerala, India

Background: Early diagnosis of hypertension in childhood is an important strategy in its control and hypertension may begin in childhood, perhaps even in infancy. The objective of the study was to To know the prevalence of hypertension and risk factors among school going children between 5 – 10 yrs of age in Thrissur District, Kerala India. Methods: 1610 school children of the age group 5-10 years from 6 schools of rural and urban regions were selected by purposive sampling method. They were subjected to anthropometric measurements after getting informed consent. Blood pressure measurements were taken using mercury sphygmomanometer as per recommendation. Hypertension is considered when blood pressure is more than 95th percentile adjusted for age and gender based on BP percentile charts. Results: Total prevalence of hypertension in this study was 4.5% and Pre-hypertension is 5.8 %. Urban school children with hypertension were 7.52% against rural were 1-2% , pre hypertension in urban school children were 9.4% ,rural 1.84% Hypertension in males were 4.31% and in females were 4.65% Prevalence of obesity in hypertension was 11 .32% against normotensive 4.61% (P <0.05). Prevalence of hypertension in children with family history of hypertension, diabetes was high and statistically significant. Conclusions: We found childhood obesity, family history of diabetes mellitus ischemic heart disease and CVA had strong association with childhood hypertension. Awareness of hypertension was very low. Periodic measurements should be done in schools to identify the high risk group of children and adolescents who can develop hypertension.

Comparison among Different Screening Tests for Diagnosis of Adolescent Hypertension

The diagnosis of childhood hypertension based upon percentile tables proposed by the international guidelines is complex and often a cause of underdiagnosis, particularly among physicians who have not had specific training in the field of adolescent hypertension. The use of a simple and accurate screening test may improve hypertension diagnosis in adolescents. The aim of our study is to compare the different screening methods currently used in the literature to improve the diagnosis of childhood hypertension. We have conducted a cross-sectional population-based study of 1412 Caucasian adolescents among students of public junior high schools of Turin, Italy. In this population we have defined the hypertensive status with four different screening tests: BPHR, Somu's equations, Ardissino, and Kaelber methods. Finally, we compared the diagnostic accuracy of the 4 screening tests with the gold standard. Our analysis identifies in BPHR the test which combines ease of use and diagnostic accuracy.

Can we recognize childhood hypertension without the use of reference tables?

s ingediend voor het Amsterdam Kindersymposium 2013 25 Can we recognize childhood hypertension without the use of reference tables? Hester Bluf pand, Merijn Bijlsma, Arend Bokenkamp Pediatric Nephrology and Oncology, VU University Medical Center INTRODUCTION Screening for childhood hypertension is increasingly advocated. However, recent studies have shown that even when blood pressure (BP) is measured and recorded, the majority of hypertensive cases are left undiagnosed. We hypothesized that unfamiliarity with normal BP values combined with the selective use of reference tables might explain the under diagnosis of childhood hypertension. METHODS A cross-sectional multicenter survey among Dutch pediatricians and pediatric residents was conducted using a questionnaire including items on frequency of BP measurement, the use of reference tables and familiarity with defi nitions of (pre)hypertension. In 12 case histories BP had to be classifi ed on the basis of age, gender and height-SDS (6 cases normotensive, 2 pre-, 2 stage I and 2 stage II hypertension). The questionnaires were completed with the researchers present and without access to reference tables. RESULTS 139 respondents (58% pediatricians) with a median experience of 9 years (IQR 3-15) participated. Respectively 87% and 80% gave the correct defi nition of prehypertension and hypertension. 71% reported only measuring BP when a child has a disease or risk factor associated with hypertension, whereas 65% reported only using reference tables when a BP value seemed high. Classifi cation of high BP was correct in 39% (prehypertension), 49% (stage I) and 59% (stage II) of the case histories. Pediatricians scored slightly better than residents (p=0.048). CONCLUSION BP is not measured routinely and reference tables are selectively consulted, often only if a BP seems high. However ‘at fi rst sight’ recognition of high BP without consulting reference tables is poor.

Population-based hypertension screening in preschool children

Hypertension is the leading risk factor for cardiovascular diseases in adults. Due to the common lack of clinical symptoms, hypertension frequently remains undiagnosed and untreated until late in the course of disorder [1, 2]. In contrast to adults, hypertension in childhood is preferentially due to secondary causes, most commonly renoparenchymal disease [3, 4]. Routine blood pressure measurements are still rarely performed by general paediatricians, and the prevalence of essential hypertension in children may be underestimated due to diagnostic neglect. Blood pressure during adolescence clearly tracks at least into early and middle adult age (“tracking” of blood pressure) [5]. Children in the top quintile of systolic blood pressure are 3–4 times more likely to develop clinical hypertension by age 30 than their peers, and 50% of hypertensive adults had elevated childhood systolic blood pressure [6]. The minimal age at which significant blood pressure tracking into adult life becomes manifest has not been determined. There are a number of possible explanations for the phenomenon of blood pressure tracking. The “fetal origins” hypothesis assumes that malnutrition during critical intrauterine growth periods leads to life-long programming of the cardiovascular system [7]. Obesity is another major determinant of childhood blood pressure. A significant association between systolic blood pressure and the body mass index has been demonstrated already in preschool children [8]. Moreover, socio-economic condition may play an independent role; associations of living conditions in childhood with adult blood pressure have been described [9]. Finally, genetic factors predisposing to hypertension would be expected to be operative already in childhood. The diagnosis of hypertension in childhood is rendered difficult by several factors. Due to the lack of outcome studies, hypertension is defined by the deviation of blood pressure from the distribution in the general population. Since blood pressure changes dynamically throughout childhood [10–12], it is critical to have a firm basis for the normal range of blood pressure at different ages and heights. Another important methodological issue is the unknown equivalence of auscultatory measurements with oscillometric readings. While semi-automatic oscillometric devices are rapidly gaining ground in the pediatric field, very few validation studies have been performed with individual devices. These suggest systematic differences between the methods in the pediatric age group, indicating a need for specific centile curves based on oscillometric measurements.

Pediatric hypertension

Pediatric hypertension