On April 21, the U.S. Preventive Services Task Force issued a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on screening for high blood pressure in children and adolescents.
Based on its review of the evidence, the USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for HBP in these populations. This is an "I" recommendation.(www.uspreventiveservicestaskforce.org)
"High blood pressure is a growing problem for children and teens in the United States," said task force member Michael Silverstein, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "Unfortunately, there is not enough evidence to determine if screening for high blood pressure in youth helps detect and prevent other health problems, such as heart disease."
The recommendation applies to children and adolescents who are not known to have hypertension. Clinicians are advised to use their own judgment about whether to screen young patients who show no signs or symptoms of the condition and to consider factors such as potential preventable burdens, potential harms and current practices.
- On April 21, the U.S. Preventive Services Task Force issued a draft recommendation statement and draft evidence review on screening for high blood pressure in children and adolescents.
- Based on its review of the evidence, the task force concluded that there was insufficient evidence to assess the balance of benefits and harms of screening.
- The task force's draft recommendation is largely consistent with its 2013 final recommendation statement.
Update of Previous Recommendation
The task force issued a final recommendation on the same topic(www.uspreventiveservicestaskforce.org) in 2013 and concluded at that time that the available evidence was insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood. The AAFP supported the recommendation at that time.
To update its previous recommendation, the USPSTF commissioned a systematic literature review on the benefits of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of CVD in childhood and adulthood. The review included 42 studies published between June 1, 2012, and Sept. 3, 2019.
The task force found no direct evidence that compared screening with no screening in asymptomatic children and adolescents. Although results from epidemiological studies indicated an association between hypertension in childhood and adolescence and hypertension in adulthood, and results from longitudinal cohort studies showed an association between hypertension in adolescents and young adults and end-stage renal disease and death from cerebrovascular events in adulthood, the proportion of spontaneous resolution of hypertension in children and long-term benefits and harms of treatment of hypertension in children and adolescents were unclear. In addition, the evidence regarding whether the diagnostic accuracy of blood pressure measurements was adequate for screening asymptomatic children and adolescents in primary care was inconclusive.
The USPSTF recommendation statement pointed to a 2017 American Academy of Pediatrics clinical practice guideline(pediatrics.aappublications.org) on screening for and managing HBP in children and adolescents that recommended, among other things, screening all patients for HBP annually and screening high-risk patients at each visit beginning at age 3 years. The Academy gave that guideline its affirmation of value designation in February 2018.
In addition, the task force's draft statement noted that whereas the AAFP's stance is that the evidence is insufficient to recommend for or against routine screening, both the American Heart Association and the National Heart, Lung and Blood Institute recommend routine screening beginning at age 3.
More Research Needed
The task force noted several evidence gaps that it said must be addressed to better understand the potential net benefits of HBP screening in children and adolescents. Specifically, additional research is needed to
- determine the accuracy of blood pressure measurements with sphygmomanometers or oscillometric automated devices and establish thresholds for hypertension for 24-hour ambulatory monitoring;
- assess the benefits and harms of pharmacologic treatments for hypertension via long-term studies;
- address the long-term natural history of hypertension in children and the spontaneous resolution of the condition;
- evaluate the associations among childhood hypertension, adulthood hypertension and surrogate measures of CVD in childhood and adulthood as well as adulthood clinical CVD; and
- assess harms of medications, long-term compliance with treatment, and the effect of individual components of multifactorial interventions.
"We know that children and teens who have high blood pressure are more likely to have it as adults, said task force member Martha Kubik, Ph.D., R.N., in the news release. "However, more research is needed on whether early identification and lowering of blood pressure in youth leads to improved cardiovascular health in youth or adults."
Opportunity to Comment
The USPSTF is accepting comments on the draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until 8 p.m. ET on May 18, 2020. All comments received will be considered as the task force prepares its final recommendation.
The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and will provide comments. The Academy will release its own recommendations on the topic after the task force finalizes its guidance.
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