Putting Prevention into Practice

An Evidence-Based Approach

Screening for High Blood Pressure in Children and Adolescents

 

Am Fam Physician. 2021 Mar 15;103(6):371-372.

Related U.S. Preventive Services Task Force Recommendation Statement: Screening for High Blood Pressure in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Author disclosure: No relevant financial affiliations.

Case Study

A 10-year-old boy with obesity and a family history significant for hypertension and hyperlipidemia presents to your clinic for a well-child examination. The parents are concerned about their child 's risk for hypertension and ask whether they should be monitoring his blood pressure.

Case Study Questions

1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for high blood pressure in children and adolescents, which one of the following recommendations should be given to the parents?

  • A. They should monitor his blood pressure at home.

  • B. Their son should be screened for high blood pressure at least annually.

  • C. No screening is needed at his age.

  • D. There is not enough information to assess the harms and benefits of screening for high blood pressure in children.

  • E. There are more concerns about secondary hypertension at his age, which requires additional testing.

2. According to the USPSTF, which one of the following is the most important risk factor for hypertension in this child?

  • A. Obesity.

  • B. Male sex.

  • C. Age.

  • D. Family history of hyperlipidemia.

  • E. He does not exhibit any risk factors.

3. According to the USPSTF, clinicians should consider which of the following when deciding whether to screen for high blood pressure in children and adolescents?

  • A. Pharmacologic interventions have been shown to improve outcomes as the child ages.

  • B. The presence of risk factors such as family history of hypertension.

  • C. Methods for measuring blood pressure in children are limited and have high false-positive rates because elevated levels in childhood usually normalize over time.

  • D. Secondary hypertension is a common diagnosis among all age groups and generally presents only with clinical manifestation of high blood pressure.

Answers

1. The correct answer is D. The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents who are asymptomatic and are

Author disclosure: No relevant financial affiliations.

References

1. Krist AH, Davidson KW, Mangione CM, et al. Screening for high blood pressure in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2020;324(18):1878–1883.

2. Gartlehner G, Vander Schaaf EB, Orr C, et al. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020;324(18):1884–1895.

3. Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417–2426.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/blood-pressure-in-children-and-adolescents-hypertension-screening.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.

 

 

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