Clinical Question

How often do children with newly diagnosed hypertension have secondary hypertension?

Bottom Line

In school or primary care settings, less than 4% of children with newly diagnosed hypertension have secondary causes compared with 20% of those referred to specialty clinics. These data are reassuring that children in primary care settings do not need extensive workup or specialty referrals. (Level of Evidence = 2a)

Synopsis

The authors searched several databases to identify studies that reported the prevalence of secondary hypertension among children with newly diagnosed hypertension. The authors included 26 studies of 2,575 children with hypertension: 19 studies were prospective and seven were retrospective; 18 studies were in school or primary care settings; and in eight studies, the participants were referred to nephrology or hypertension clinics. The studies were at low or moderate risk of bias. Although the approaches to diagnosing secondary hypertension varied, all were acceptable based on current guidelines. Among the participants, 457 (17.7%) were found to have secondary hypertension, but with a high degree of heterogeneity. The prevalence of secondary hypertension was markedly different by setting (3.7% in school or primary care settings; 20.1% in referral settings), but significant heterogeneity remained (78.9% and 94.6%, respectively). The authors found no evidence of publication bias.