Screening for Hypertension in Children and Adolescents

Abstract

ImportanceChildhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks.ObjectiveTo update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force.Data SourcesPubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020.Study SelectionFair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions.Data Extraction and SynthesisTwo reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively.Main Outcomes and MeasuresSensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments.ResultsForty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were −4.38 mm Hg (95% CI, −7.27 to −2.16) for angiotensin-converting enzyme inhibitors and −3.07 mm Hg (95% CI, −4.99 to −1.44) for angiotensin receptor blockers. Candesartan reduced SBP by −6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (−4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (−2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (−7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure.Conclusions and RelevanceObservational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.

Association Between Triglyceride-Glucose Index and Hypertension: A Meta-Analysis

“…Currently, hypertension remains an important cause of morbidity and mortality of global population (1), particularly for people from the developing countries (2). Early identification of population at higher risk for the development of hypertension is critical to reduce the incidence of the disease and its cardiovascular complications (3). Previous studies showed that insulin resistance may be involved in the pathogenesis of hypertension via mediating low-degree systematic inflammation (4,5).…”

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“…Лечение аторвастатином значительно снижало сывороточные уровни miR-122. В течение 15 лет люди с более высоким уровнем miR-122 на исходном уровне были подвержены повышенному риску развития метаболического синдрома или СД 2 типа [16]. В другой группе пациентов до развития СД , miR-192 и miR-193b положительно коррелировали с триглицеридами в сыворотке крови.…”

“…В педиатрии эта проблема остается одной из приоритетных, что связано с распространенностью АГ в детской популяции [1,3,6,15] и высокой вероятностью ее трансформации в ишемическую и гипертоническую болезни взрослых [2,5,7,10,14]. АГ среди детей и подростков наблюдается в зависимости от возраста и избранных критериев у 2,4-18% [9,11,16,17]. Вариабельность результатов эпидемиологических исследований в РФ может быть обусловлена климато-географическими, экологическими и этническими особенностями, а также различиями возрастно-половых групп обследуемых [4,8,12,13].…”

Screening for High Blood Pressure in Children and Adolescents

“…The USPSTF commissioned a systematic evidence review to update its 2013 recommendation on screening for high blood pressure in children and adolescents . The USPSTF reviewed the evidence on the benefits of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood.…”