Screening For Hypertension In Children Research Articles

Study on the relationship between body mass index and blood pressure indices in children aged 7-17 during COVID-19.

To explore the relationship between body mass index (BMI), age, sex, and blood pressure (systolic blood pressure, SBP; diastolic blood pressure, DBP) in children during COVID-19, providing reference for the prevention and screening of hypertension in children. This study adopted a large-scale cross-sectional design to investigate the association between BMI and blood pressure in 7-17-year-old students in City N, China, during COVID-19. Thirty-six primary and secondary schools in City N were sampled using a stratified cluster sampling method. A total of 11,433 students aged 7-17 years in City N, China, were selected for blood pressure (Diastolic blood pressure, DBP, Systolic blood pressure, SBP), height, and weight, Resting heart rate (RHR), chest circumference, measurements, and the study was written using the STROBE checklist. Data analysis was conducted using SPSS 26.0, calculating the mean and standard deviation of BMI and blood pressure for male and female students in different age groups. Regression analysis was employed to explore the impact of BMI, age, and sex on SBP and DBP, and predictive models were established. The model fit was evaluated using the model R2. The study included 11,287 primary and secondary school students, comprising 5,649 boys and 5,638 girls. It was found that with increasing age, BMI and blood pressure of boys and girls generally increased. There were significant differences in blood pressure levels between boys and girls in different age groups. In regression models, LC, Age, BMI, and chest circumference show significant positive linear relationships with SBP and DBP in adolescents, while RHR exhibits a negative linear relationship with SBP. These factors were individually incorporated into a stratified regression model, significantly enhancing the model's explanatory power. After including factors such as Age, Gender, and BMI, the adjusted R2 value showed a significant improvement, with Age and BMI identified as key predictive factors for SBP and DBP. The robustness and predictive accuracy of the model were further examined through K-fold cross-validation and independent sample validation methods. The validation results indicate that the model has a high accuracy and explanatory power in predicting blood pressure in children of different weight levels, especially among obese children, where the prediction accuracy is highest. During COVID-19, age, sex, and BMI significantly influence blood pressure in children aged 7-17 years, and predictive models for SBP and DBP were established. This model helps predict blood pressure in children and reduce the risk of cardiovascular diseases. Confirmation of factors such as sex, age, and BMI provide a basis for personalized health plans for children, especially during large-scale infectious diseases, providing guidance for addressing health challenges and promoting the health and well-being of children.

The importance of screening for hypertension in children and adolescents

Hypertension (HTN) is the most prevalent chronic non-infected disease and the greatest cause of adult premature mortality. Although in the past clinicians assumed that HTN in childhood and adolescents is uncommon, it is currently a significant public health issue and this narrative review aimed to assess the new finding regarding screening for HTN in Children and adolescents. Relevant English publications were extracted from Web of Science, PubMed, Scopus, and Google Scholar. As there are gaps regarding recommendations, guidelines, and screening for HTN in children and adolescents, this review tried to notice some important points.

Pulmonary hypertension screening in children with sickle cell disease.

Screening for pulmonary hypertension (PHT) is recommended in children with sickle cell disease (SCD). However, best approaches are poorly described. We examined the utility of PHT symptoms, echocardiogram (ECHO), N-terminal-pro hormone brain natriuretic peptide (NT-proBNP), and BNP to screen for PHT in the SCD pediatric population. Children (8-18years old) with SCD-HbSS and HbSthal° were prospectively included and underwent PHT screening. The screening consisted of a comprehensive PHT symptoms evaluation, ECHO measurement, and NT-proBNP and BNP levels. A total of 73 patients were included (mean age 12±5.7years; >80% on hydroxyurea), of which 37% had a symptom consistent with PHT, including exertional dyspnea (26.5%), fatigue (17.6%), palpitation (14.7%), and chest pain (10.3%). ECHO was obtained in 53 (72.6%) patients, with only ECHO of 48 patients included in the final analysis. Elevated ECHO peak tricuspid regurgitant jet velocity (TRV) >2.5m/s or indirect findings to suggest PHT were seen in only two of 48 (4.2%). No significant differences were seen between those with and without PHT symptoms when compared for NT-proBNP, BNP, hemoglobin, pulmonary function testing, fractional exhaled nitric oxide, asthma, oxygen saturation, and sleep apnea. PHT symptoms are not consistent with ECHO, NT-proBNP nor BNP findings in children with SCD. PHT prevalence based on TRV was low in children on hydroxyurea, therefore screening may not be warranted for this group.

Screening for Hypertension in Children With and Without Autism Spectrum Disorder

Screening for Hypertension in Children With and Without Autism Spectrum Disorder

Pediatric hypertension screening and recognition in primary care clinics in Canada.

Screening for hypertension in children is recommended by pediatric consensus guidelines. However, current practice is unknown. We evaluated rates of blood pressure assessment and hypertension recognition in primary care. This retrospective cohort study evaluated electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network between 2011 and 2017. Children aged 3 to <18 years with at least one clinical encounter were included. Screening, follow-up, and hypertension recognition rates were evaluated. Descriptive statistics and multivariate logistical regression were used to determine patient and provider characteristics associated with increased screening and recognition of pediatric hypertension. Among 378,002 children, blood pressure was documented in 33.3% of all encounters, increasing from 26.7% in 2011 to 36.2% in 2017; P=0.007. Blood pressure was documented in 76.0% of well child visits. Follow-up visits occurred within 6 months for 26.4% of children with elevated blood pressure, 57.1% of children with hypertension, and within 1 month for 7.2% of children with hypertension. Patient factors associated with increased blood pressure screening include being overweight (OR 2.15, CI 2.09 to 2.22), having diabetes (OR 1.69, CI 1.37 to 2.08), chronic kidney disease (OR 7.51, CI 6.54 to 8.62), increased social deprivation (OR 1.10, CI 1.09 to 1.11), and urban residence (OR 1.27, CI 1.15 to 1.4). Overall prevalence of hypertension was 1.9% (n=715) and of those, 5.6% (n=40) had recognized hypertension. Factors associated with increased recognition include male sex, overweight, and hyperlipidemia. Rates of hypertension screening and recognition are low in primary care settings in Canada, suggesting pediatric hypertension should be a priority for implementation and dissemination of interventions.

Updated Guideline May Improve the Recognition and Diagnosis of Hypertension in Children and Adolescents; Review of the 2017 AAP Blood Pressure Clinical Practice Guideline.

Hypertension in children and adolescents is under-recognized and under-diagnosed in clinical practice. The 2017 AAP Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents provides updated recommendations that may improve hypertension identification and management. The AAP blood pressure guideline recommends annual screening for hypertension in children at preventive care visits and targeted routine screening in high-risk populations. A simplified blood pressure screening table is provided for easier recognition of blood pressures that may require attention. Normative blood pressure tables have been revised to include only data from normal-weight children as more representative of a healthy population. Classification of blood pressure in adolescents has been simplified to threshold values consistent with adult guidelines. The updated AAP blood pressure guideline has clarified and simplified recommendations for hypertension screening, diagnosis, and management based on a systematic review of current best evidence.

Study of blood pressure profile and anthropometry in children belonging to low socio-economic status; a prospective cross sectional study

Background: A significant number of population in India are below poverty line. It contributes to the higher incidence of malnutrition especially among children which is 48% according to NFHS-3 (National family Health survey). Blood Pressure tracking studies suggest that hypertension in adulthood often has its origin in childhood. Blood pressure in childhood is the best predictor of hypertension in later life. There have been very few studies on malnutrition and Hypertension association and none in this area. One rationale for screening for hypertension in children and adolescents is that early identification of primary hypertension could lead to interventions to reduce blood pressure during childhood and adolescence, resulting in a reduced risk for cardiovascular events and death in adulthood.Methods: The present cross sectional prospective study was conducted on School going children (5-14 years) belonging to lower socio-economic status attending schools from Bhilai, DistrictDurg Chhattisgarh, India, within 5 km range of Chandulal Chandrakar Memorial Hospital over a period of 12 months from March 2015 to February 2016.The present study took 300 sample size. List of schools was arranged from district education officer (DEO) and required government schools were shortlisted on within 5 km range of hospital. After short history and examination, as per the prerequisite of proforma, the following measurements were taken. For all the statistical analysis MS EXCEL and SPSS 16 (Statistical Package for Social Science) version were used. The information collected was tabulated and the data was analyzed using suitable statistics.Results: 60% of the subjects were belongs to 5-10 years of age and 40% in 10-14 years’ age group. Males and females were equal in distributions (50% each), thus there were 150 males and 150 females in the current study. Overall prevalence of malnutrition in our study was 38.6%. The present study found 88 subjects (29.3%) having grade 1 malnutrition and 28 subjects (38.7%) having grade 2 and 0 (0%) with grade 3 and grade 4 malnutrition. There were 2 pre-hypertensives in our study, out of which one was male and one female. When analyzed according to nutritional status, there were 2 hypertensives in malnourished group. Similarly. there was 1 hypertensive in normal nutritional status group.Conclusions: There is a significant prevalence of malnutrition in our society which contributes to a more number of problems than what is presented to practicing paediatricians. The prevalence is higher in children &lt;5 years age group overall which continues through school age and adolescent age group as shown in our study. The focus of attention should be identification of various diseases along with hypertension at the earliest and prevention of malnutrition.

Screening for Hypertension in Children and Adolescents: Methodology and Current Practice Recommendations.

Hypertension (HTN) requires urgent, uniform, and consistent attention across all frontiers of pediatric health care not only because of established links between the onset of HTN during one’s youth and its sustenance throughout adulthood but also because of the sequelae associated with the disease’s trajectory, such as cardiovascular disease, end organ damage, and decreased quality of life. Although national guidelines for the diagnosis and management of pediatric HTN have been available for nearly 40 years, knowledge and recognition of the problem by clinicians remain poor due to a host of influencing factors. The purpose of this article is to explicate key issues contributing to the inaccurate measurement of blood pressure and misclassification of HTN among children and to present strategies to address these issues.

Impact of ambulatory blood pressure monitoring on the diagnosis of hypertension in children

Screening of hypertension in children commonly starts with office measurement of the blood pressure according to the Fourth Report. The latter however does not account for masked hypertension (MH) on the one hand and white coat hypertension (WCH) on the other. We aimed to investigate in a single large pediatric population how much the addition of ambulatory blood pressure monitoring (ABPM) helps to refine the allocation to the different classes of blood pressure. In a retrospective study, we reclassified the records of a cohort of 500 children, who attended our department for investigation of possible hypertension, according to the Fourth Report and the revised ABPM interpretation scheme. As expected, ABPM interpretation scheme detected MH and WCH; however, 14% of children evaluated according to this scheme did not fit in any categories. On the other hand, applying the Fourth Report criteria, 80% of prehypertensive children ended up in the uncategorized or the MH groups. Our data confirm that ABPM detects the cases of MH and WCH, and minimizes the misplacement of prehypertensive children; unfortunately however, it also leaves a significant number of patients remain unclassified.

Performance of parental history for the targeted screening of hypertension in children

Several guidelines recommend universal screening for hypertension in childhood and adolescence. Targeted screening to children with parental history of hypertension could be a more efficient strategy than universal screening. Therefore, we assessed the association between parental history of hypertension and hypertension in children, and estimated the sensitivity, specificity, negative, and positive predictive values of parental history of hypertension for hypertension in children. The present study was a school-based cross-sectional study including 5207 children aged 10-14 years from all public 6th grade classes in the Canton of Vaud, Switzerland. Children had hypertension if they had sustained elevated blood pressure over three separate visits. In children, the prevalence of hypertension was 2.2%. Some 8.5% of mothers and 12.9% of fathers reported to be hypertensive. Maternal history of hypertension (odds ratio 2.0, 95% confidence interval 1.2-3.3) and paternal history of hypertension (odds ratio 2.2, 95% confidence interval 1.4-3.6) were independent risk factors for hypertension in children. Nevertheless, the sensitivity of parental history of hypertension for the identification of hypertension in children was low (from 4% for both parents' positive history up to 41% for at least one parent's positive history). Positive predictive values were also low (between 4 and 5%). Children with hypertensive parents were at higher risk of hypertension. Nevertheless, parental history of hypertension helped only marginally to identify hypertension in offspring. Targeting screening only toward children with a parental history of hypertension may not be a substantially better strategy to identify hypertension in children compared with universal screening.

Performance of parental history of hypertension for the screening of hypertension in children

Background Several guidelines recommend universal screening for hypertension in childhood and adolescence for the early prevention of cardiovascular diseases. However, this recommendation has been challenged. Targeting screening of hypertension toward children with a family history of hypertension has been proposed. Our goals were to assess the association between parental history of hypertension and hypertension in children and to estimate the performance (i.e., …

Response to “U.S. Preventive Services Task Force Recommendation and Pediatric Hypertension Screening: Dereliction of Duty or Call to Arms?”

The U.S. Preventive Services Task Force (USPSTF) recently published their recommendation on pediatric hypertension screening. Based on an evidence review of the literature on 8 key questions, the USPSTF concluded that “there is no direct evidence to suggest that screening for hypertension in children reduces adverse cardiovascular outcomes in adults.” The implication of the USPSTF recommendation is that routine blood pressure (BP) measurement in asymptomatic children and adolescents is of little benefit. The USPSTF publication has provoked considerable alarm among the pediatric community, especially among specialists in cardiovascular and renal disease. There is general concern that the USPSTF report will be interpreted as grounds for abandoning BP measurements in childhood. Indeed, a recent “evidence-based” publication has recommended stopping BP measurement in children. In this issue of The Journal of Clinical Hypertension, Drs Lo, Malaga-Dieguez, and Trachtman propose a series of reasons why, in their opinion, the USPSTF may have done the subspecialty of pediatric hypertension a great service. We disagree and will consider these authors’ main points below. First, the authors conclude that “there is little risk of a policy that advocates deferring routine measurement of BP in asymptomatic children.” As a public health policy, it could be true that the child population risk may be small if BP measurement in asymptomatic children were abandoned. However, child health care is generally provided by physicians or other trained primary care providers, and the focus of primary care is to optimize health in the individual child, not the childhood population. It is well established that elevated BP is a risk factor for adverse health outcomes in individuals. There is sufficient observational data which confirm that this risk holds true for individual children as well as adults. Thus, abandonment of routine childhood BP measurement has the potential to increase risk in individual children by failing to detect conditions that are associated with elevated BP. In considering routine BP measurement from an economic perspective, the authors concur that “practice guidelines that help balance the benefits of a procedure or treatment are valuable even for seemingly innocuous tests such as measurement of BP in children.” It is unclear what the authors’ point is about the costs of routine BP measurement in all children vs the costs of evaluating and managing a child with symptomatic hypertension. All newborn infants undergo routine blood screening for inborn errors of metabolism and metabolic disorders; this screening is more invasive, laboratory costs are not trivial, and the conditions are rare. Relative to what is now standard newborn screening, the economic cost-benefit equation of childhood BP screening is not significant and hardly sufficient to abandon the practice. The authors question whether the USPST has abdicated its responsibility to promote cost-effective procedures that will improve the health of children and undermined efforts to educate doctors and lay people about the importance of hypertension. However, they consider it “premature to answer this question based on what is known.” As noted by Urbina and colleagues, the USFPTF recommendation ignores a substantial body of literature that includes many relevant observational studies, especially those that document intermediate outcomes associated with childhood hypertension such as cardiac hypertrophy, carotid artery thickening, and albuminuria. Thus, there is “evidence” well beyond that deemed acceptable to the USPSTF that contributes knowledge on the evolution of hypertension beginning in childhood. Lo and colleagues, like the USPSTF, have apparently failed to accept much that is known on target organ damage both among adults with known high BP in childhood and among hypertensive children. As an alternative to measuring BP and identifying hypertension, or prehypertension, in childhood, the authors suggest “we could advance global strategies to reduce weight, increase physical activity, and foster healthy lifestyle choices that will correct obesity and in all likelihood restore normal BP. . . .” While this approach may be theoretically plausible, little, if any, success has been achieved despite considerable efforts to approach these goals. Moreover the pace of success with global strategies is too slow for those adolescents who currently have hypertension with or without obesity. As estimated by Brady and colleagues, with elimination of BP screening, from 106,793 to 320,378 adolescents with primary hypertension would not be identified and, considering the number of missed diagnoses, this estimate could be higher. In addition, girls with obesity-associated hypertension who enter young adult childbearing years will have high-risk pregnancies and high-risk offspring. Address for correspondence: Bonita Falkner, MD, Department of Medicine and Pediatrics, Thomas Jefferson University, 833 Chestnut Street, Suite 700, Philadelphia, PA 19107 E-mail: bonita.falkner@jefferson.edu

Gaps in the Evidence for Screening Children for Hypertension to Prevent Adult Cardiovascular Disease—Response to the Editorial by Samuels and Colleagues

Gaps in the Evidence for Screening Children for Hypertension to Prevent Adult Cardiovascular Disease—Response to the Editorial by Samuels and Colleagues

Observational Studies May Be More Important Than Randomized Clinical Trials

On behalf of the Atherosclerosis, Hypertension, and Obesity in Youth committee of the American Heart Association (AHA), we appreciate the opportunity to comment on the recently published US Preventive Services Task Force (USPSTF) recommendation statement on Screening for Hypertension in Children and Adolescents (Table).1 View this table: Table. USPSTF Recommendations on Screening for Primary Hypertension (10 HTN) in Children and Adolescents* Since the 1970s, the National Heart, Lung, and Blood Institute has recommended measurement of blood pressure (BP) in healthy children as part of routine health maintenance.2,3 The American Academy of Pediatrics4 and the AHA also advocate this approach.5,6 Recently, the USPSTF concluded that the “current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease (CVD) in childhood or adulthood.”7 The USPSTF approach, which limits the allowable evidence, primarily to randomized controlled trials, and additionally fails to address important questions on pediatric BP, may lead to an undervaluing of pediatric BP measurement and may contribute to practitioner confusion. The USPSTF performed an evidenced-based review to address the use of BP screening in childhood. The task force developed 8 key questions and performed a literature review that netted 6435 potentially relevant articles. After abstract review, 1059 articles were selected as applicable to the key questions, and they underwent full text review. Only 35 articles (describing 34 studies) were included in the statement. The others were excluded as wrong population, intervention, outcome, study design, language, duration, no original data, inadequate duration, or inadequate reference standard. The search strategy, key questions, and references can be found at …

Patterns of Care and Persistence After Incident Elevated Blood Pressure

Screening for hypertension in children occurs during routine care. When blood pressure (BP) is elevated in the hypertensive range, a repeat measurement within 1 to 2 weeks is recommended. The objective was to assess patterns of care after an incident elevated BP, including timing of repeat BP measurement and likelihood of persistently elevated BP. This retrospective study was conducted in 3 health care organizations. All children aged 3 through 17 years with an incident elevated BP at an outpatient visit during 2007 through 2010 were identified. Within this group, we assessed the proportion who had a repeat BP measured within 1 month of their incident elevated BP and the proportion who subsequently met the definition of hypertension. Multivariate analyses were used to identify factors associated with follow-up BP within 1 month of initial elevated BP. Among 72,625 children and adolescents in the population, 6108 (8.4%) had an incident elevated BP during the study period. Among 6108 with an incident elevated BP, 20.9% had a repeat BP measured within 1 month. In multivariate analyses, having a follow-up BP within 1 month was not significantly more likely among individuals with obesity or stage 2 systolic elevation. Among 6108 individuals with an incident elevated BP, 84 (1.4%) had a second and third consecutive elevated BP within 12 months. Whereas >8% of children and adolescents had an incident elevated BP, the great majority of BPs were not repeated within 1 month. However, relatively few individuals subsequently met the definition of hypertension.

Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease

The prevalence of hypertension is increasing in children, and may persist into adulthood. This systematic review was conducted for the US Preventive Services Task Force recommendation on the effectiveness of screening asymptomatic children and adolescents for hypertension in order to prevent cardiovascular disease. Eligible studies were identified from Medline and the Cochrane Library (through July 2012). We included trials and controlled observational studies in asymptomatic children and adolescents on the effectiveness and harms of screening and treatment, as well as accuracy of blood pressure measurement. One author extracted study characteristics and results, which were checked for accuracy by a second author. No studies evaluated the effects of screening for hypertension on health outcomes. Two studies of screening tests for elevated blood pressure reported moderate sensitivities (0.65, 0.72) and specificities (0.75, 0.92). Sensitivities and specificities of child hypertension for the later presence of adult hypertension (7 studies) were wide ranging (0-0.63 and 0.77-1.0, respectively), and associations between child hypertension and carotid intima media thickening and proteinuria in young adults (3 studies) were inconsistent. Seven studies reported that drug interventions effectively lowered blood pressure in adolescents over short follow-up periods. No serious treatment-related adverse effects were reported. There is no direct evidence that screening for hypertension in children and adolescents reduces adverse cardiovascular outcomes in adults. Additional studies are needed to improve diagnosis and risk stratification of children with elevated blood pressure and to quantify risks and benefits of interventions.

Evaluating risk factors in hypertension screening in children and adolescent

used body mass index (BMI) anddual-energy X-ray absorptiometry (DXA),which is a more accurate method for assessingbody composition, as DXA assesses threeaspects of body composition: bone mineral,lipids (triglycerides, phospholipid membranesand so on) and lipid-free soft tissue. Fromthese data, we can estimate fat mass, lean softtissue mass, fat-free mass, soft tissue mass,total body mass and percent fat mass.

Number of blood pressure measurements needed for screening of hypertension in children and adolescents

Background Routine blood pressure assessment is recommended because childhood hypertension is significantly associated with increased risk of cardiovascular disease in adulthood. However, results of blood pressure measurements in children are highly variable, associated with the risk of under or over-diagnosing in hypertension.Objective To assess the optimal number of measurements to screen elevated blood pressures in children and adolescents.Methods This study used two sets of data, i.e. a dataset from 104 obese and non-obese, male and female primary school-children, and a dataset from 79 obese female adolescents. Blood pressure (BP) was measured using standard techniques described by the fourth report of the National High Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents. Elevated BP was defined as systolic and diastolic BP at or above the 90th percentile for gender, age, and height.Results BP measurements taken on day-one were significantlyhigher than those taken on day-two and three. This led tohigher prevalence of elevated BP when only one measurementwas performed. Using the average of two measurements in twooccasions detected elevated blood pressure with specificity andpositive predictive value (PPV) ranged from 0. 74 to 1.0 and 0.58to 1.0, respectively.Conclusions It is necessary to measure blood pressure repeatedly to minimize the risk of over-diagnosing in hypertension in children and adolescents. Using the average of three measurements in three visits is recommended, but drawing conclusions based on two measurements in two occasions have yielded sufficiently high specificity.