Easier pediatric blood pressure screening

October 1, 2009
Andrew J Schuman, MD, FAAP

Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and editorial advisory board member of Contemporary Pediatrics.

David Kaelber, MD, PhD, MPH

Dr. Andrew Schuman recently sat down with Dr. David Kaelber to discuss the implications of his vastly simplified screening tool for pediatric hypertension.

Recently, Kaelber and colleagues created a simplified BP table for screening children for hypertension or prehypertension (TABLE 1 in the print and digital editions).3 The new table reduces the number of BP values from 476 in the Fourth Report to just 64, and has only one threshold value of abnormal systolic and diastolic BP, by gender, for each year of life (ages 3 to 18). These modifications make it easy to identify abnormal BP values in almost any potential care or screening setting.

Q: Pediatricians screen for a wide variety of conditions at well-child visits including hearing, vision, lead exposure, anemia, developmental issues, and obesity, just to name a few. Why should pediatricians also be aware of age-related thresholds for hypertension and prehypertension?

Q: Your simplified table is derived from tables published in the Fourth Report. Pediatricians can find these tables reproduced in the Harriet Lane Handbook. Why is a simplified table needed?

a: The traditional BP tables are complex because they incorporate a child's age, gender, and height percentile. This simplified table only relies on age and gender. This simplification is important because it reduces the complexity of the BP table, and focuses on easily identifiable information. When an intake person checks BP at a routine office visit, or a BP screening is provided at a school, a whole additional level of time and complexity is needed if in addition to noting the BP, one must also measure the child's height and then plot their height percentile. These additional challenges may discourage providers from offering opportunities for BP screening outside the well-child visit.