- by Dr Gowher Yusuf
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- May 02 2017
To Screen or Not to Screen; Debate on Whether to Routinely Measure BP in Kids
Doctors are at odds as to whether or not to universally screen children and adolescents for high blood pressure. The contradictory advice comes in two papers published online January 8, 2013 in JAMA Paediatrics.
In the first, a review article, Dr Arnaud Chiolero (Institute of Social and Preventive Medicine, Lausanne, Switzerland) and colleagues say there is "no compelling evidence in favour of universal BP screening among healthy children." But in an accompanying editorial, paediatricians Dr Stephen R Daniels and Samuel S Gidding (University of Colorado School of Medicine, Aurora) argue that a number of bodies, including the US National Heart, Lung, and Blood Institute (NHLBI) and the American Academy of Paediatrics, recommend routine measurement of BP in children starting at age three.
Not Whether to Measure BP, But What Is Hypertension in Childhood? While Chiolero et al acknowledge that the US NHLBI and others, such as the European Society of Hypertension, do advise universal screening, "no study has experimentally evaluated the benefits and harms of BP screening in children," they point out. And they note that the US Preventive Services Task Force concludes there is no sufficient evidence to recommend for or against screening, although this body is in the process of updating its guidance, they note.
"Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies," they conclude.
Daniels and Gidding say that Chiolero et al do make some important points, including the fact that "the definition of hypertension in children needs refinement and better alignment with adverse health outcomes." We believe the focus of this discussion should not be on whether BP should be measured in children but rather on the optimal definition of high BP in childhood.
The current approach to defining elevated BP in kids--which incorporates age, sex, and height as well as multiple cut points for hypertension diagnosis--"is too cumbersome," say the US paediatricians. And in fact, they argue that this is the more burning issue: "We believe the focus of this discussion should not be on whether BP should be measured in children but rather on the optimal definition of high BP in childhood."
Also, while Chiolero et al present concerns about potential harm related to BP screening, such as anxiety and labelling, "they provide no evidence that such harms occur," say the American doctors. They agree, however, with Chiolero et al's calls for population-based approaches to lowering BP--such as reducing sodium in the diet and increasing physical activity--but note "population-based approaches should be combined with individual, high-risk preventive strategies . . . not be pitted against each other."
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