The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for primary hypertension in asymptomatic children and adolescents.
Hypertension in children and adolescents has increased over the past several decades, which may be attributable to the climb in childhood overweight and obesity rates, according to background information. An estimated 11% of obese children in the U.S. suffer from hypertension, putting them at increased risk for hypertension in adulthood.
One rationale for screening young patients is that it could lead to interventions that reduce blood pressure and reduce the risk for cardiovascular events and death in adulthood. However, there might also be harms associated with early treatment, such as adverse events during pharmacologic treatment periods.
A review of evidence published since the task forces 2003 recommendation found insufficient evidence to draw conclusions about the balance of the benefits and harms of screening.
Studies in this area have been of short duration, according to the review. Trials of the efficacy of antihypertension drugs were typically four weeks in duration, whereas studies of lifestyle interventions ranged from two months to three years with a median duration of seven months.
A 2012 analysis of data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey found that screening was done during 67% of preventive care visits and 35% of ambulatory visits. Screening was more common in children who were overweight or obese, with 84% of preventive visits including hypertension screening. Older children were more likely to be screened.
The recommendation was published Oct. 7 on the websites of the journals Pediatrics and the Annals of Internal Medicine: http://annals.org/article.aspx?articleid=1747317