MONDAY, Feb. 25 (HealthDay News) -- Despite a worrisome increase
in obese and hypertensive children and teens, not enough evidence
exists to justify routinely screening young people for high blood
pressure, a new report says.
The U.S. Preventive Services Task Force reviewed existing
research and concluded that it's unclear whether treating high
blood pressure in children and adolescents controls hypertension
long-term or leads to better heart health in adulthood.
Given the lack of convincing evidence either for or against
screening, the panel has decided not to make any recommendation.
However, it is calling for more research on the benefits and risks
The task force report, published online Feb. 25 in the journal
Pediatrics, said doctors considering whether to screen or
not should take into account "current scientific research, expert
opinion, their own knowledge and experience, as well their
patient's health history along with the preference of the patient
In the United States, between 1 percent and 5 percent of
children and teenagers have high blood pressure, and among obese
youth, the rate is higher -- 11 percent, the task force said. The
rise in childhood hypertension seen over the last few decades is
probably a result of the obesity epidemic, the task force
In light of this increase, the panel's stance concerns some
"I hope pediatricians when they read this don't think because there is no established direct correlation between screening for hypertension [in kids] and cardiovascular risk factors in adulthood that screening doesn't need to be done," said Dr. Ana Paredes, director of renal research at Miami Children's Hospital in Florida, who had no part in the report.
"It is extremely important to screen children and adolescents for hypertension," she said. "That's the official position of the American Academy of Pediatrics."
The academy also says that if high blood pressure persists, it
can lead to heart failure or stroke in adulthood.
Paredes said she sees many young patients with high blood
pressure today. "We are having an epidemic of hypertension, mainly
in preteens and teenagers, related to overweight and obesity," she
However, Paredes doesn't believe most children with high blood
pressure need to take medications to lower their pressure or to
The first approach involves lifestyle changes, including a
healthy diet and lots of exercise, which usually reduce blood
pressure, she said.
Only a few children with special medical problems would need to
take blood pressure or cholesterol medications, she added.
The task force statement applies only to children and teens with
no signs or symptoms of a health problem such as kidney trouble or
diabetes. In those cases, controlling high blood pressure could be
part of the treatment.
Task force member Dr. Kirsten Bibbins-Domingo, said, "We are all
concerned about preventing cardiovascular disease, and hypertension
in adults is a very important risk factor that when we treat
actually helps prevent cardiovascular disease."
However, "in children there is not enough solid evidence to
suggest that identifying and treating hypertension in childhood
actually helps in this prevention," she added. "There is not enough
solid evidence to make a recommendation for or against identifying
high blood pressure in childhood and treating it."
Bibbins-Domingo, who is an associate professor of medicine and
epidemiology and biostatistics at the University of California, San
Francisco, said it's up to individual doctors whether or not to
screen children and teens.
Further research is needed to settle the issue, she suggested.
This includes assessing any adverse effects of screening, including
labeling and anxiety, the task force said.
Another expert believes screening children and teens for high
blood pressure is worthwhile even without a lot of data to support
"Screening children and adolescents for elevated blood pressure allows for earlier detection and has the potential to allow effective lifestyle modification to begin earlier in life," said Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles. This could reduce the risk of death and disability from cardiovascular disease in adulthood, he explained.
This review did not identify any studies directly evaluating the
effects of blood pressure screening on health outcomes, Fonarow
"However, a number of studies were identified that showed that when elevated blood pressure was identified it could be safely and effectively lowered in children and adolescents," he said.
The task force, an independent group of experts in prevention
and evidence-based medicine working to improve Americans' health,
welcomes public comment on this report until March 25.
For more on high blood pressure in children, visit the
American Heart Association.
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