USPSTF: Jury still out on hypertension screening in pediatrics

Hypertension can have a significant impact on health and the guidelines on whether to screen for hypertension in children and teenagers can vary depending on the organization. A draft recommendation from the US Preventive Services Task Force (USPSTF) states that the evidence to support hypertension screening and the balance of harms and benefits can’t be determined.¹ The recommendation is open for comment until May 18, 2020.

Investigators looked at 42 studies on pediatric hypertension. One fair-quality study examined the accuracy of hypertension screenings. Twenty studies looked at the link between hypertension in childhood and hypertension in adulthood, which was confirmed in spite of different definitions of elevated blood pressure in children and hypertension in adults. Twenty-one studies examined treatment of hypertension in children. All the studies showed that pharmacologic treatments reduced systolic and diastolic blood pressure, but the difference did not always reach statistical significance. Three studies looked at the impact of diet or exercise on reducing hypertension. Dietary changes only lasted as long as the intervention continued and the benefit of exercise on systolic blood pressure was seen only when the intervention period was 8 months, not when the intervention period was shorter.

Using this literature review, the USPSTF had the following conclusions:

·      Inadequate evidence exists that supports the accuracy of high blood pressure in children and adolescents.

·      No direct evidence shows that screening for high blood pressure delays or reduces adverse outcomes.

·      Adequate evidence supports the longitudinal association between high blood pressure in children and adolescents and high blood pressure and other outcomes in adults.

·      A lack of evidence exists that supports the long-term effectiveness of all intervention in treating high blood pressure in the pediatric population.

·      There is inadequate evidence supporting the effectiveness of high blood pressure intervention in pediatric care resulting in reduced adverse outcomes tied to high blood pressure in adulthood.

·      Not enough evidence exists to assess the potential harms caused by screening children and adolescents for high blood pressure.

·      There is not enough evidence to assess the potential harms of inventions for treating high blood pressure in children and adolescents.

References:

1.    US Preventive Services Task Force. Draft Recommendation Statement: High blood pressure in children and adolescents: screening. Published April 21, 2020. Accessed April 23, 2020. https://www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-recommendation-statement&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020#tab