Check Kids for High Blood Pressure?

A new recommendation from the U.S. Preventive Services Task Force says we don't actually know if the age-old practice is a good idea.

This is the current directive information available for U.S. parents, from the National Institute of Diabetes and Digestive and Kidney Disease, with regard to getting their kids' blood pressures checked:


It's definitive. Eleven percent of obese kids have high blood pressure, so attention to this is growing, but even non-obese kids have a 1 to 5 percent chance.

Today, though, the U.S. Preventive Services Task Force—a group of experts that reviews research to guide preventive healthcare practices—issued a statement that says we really don't have evidence to say that we should be checking every child's blood pressure. It is published in the major medical journals Pediatrics and Annals of Internal Medicine. An excerpt:

No direct evidence demonstrated that screening children and adolescents for hypertension [high blood pressure] is effective in delaying the onset of or reducing the risk for adverse cardiovascular health outcomes related to hypertension, either in childhood or adulthood.

No studies reported on the effectiveness of treatments for primary childhood hypertension and subsequent reduction of blood pressure or other intermediate cardiovascular outcomes in adults.

Checking blood pressure might be the most basic thing that happens when a kid goes to a pediatrician. It seems innocuous—quick and cheap, and it can occasionally result in diagnosing a heart or kidney condition that has no symptoms. The issue, though, is what to do with a diagnosis of hypertension once it's made. As a general practice, the task force says, the few potential benefits of knowing don't make the simple testing worthwhile.

"We don't know if lowering blood pressure in youth leads to improved cardiovascular health in adulthood," task-force member and UCSF professor Kirsten Bibbins-Domingo, M.D., said in a news release. "We also don't know the long-term benefits and harms for children and adolescents who initiate blood pressure medications when they are young."

This is one of those interesting reminders that we still know very little, and common practices in all fields of medicine are always worth testing and reconsidering.

"While there is much we don't know," Bibbins-Domingo said, "we do know that eating a healthy diet, being active, and maintaining a normal weight are ways children and teens can improve their cardiovascular health."

When debating these sorts of screening tests, another factor that commonly comes up is the false sense of security that a normal test result can give. That is, just because a kid has a normal blood pressure doesn't mean he's eating well and exercising enough, etc.

Complete information about this for parents is available in a patient-oriented Annals article that is published today alongside the official statement, and is free to all. The bottom line, from the task force: "Until further information becomes available, the doctor and patient should make a decision to screen on the basis of the patient's specific situation."

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James Hamblin, MD, is a senior editor at The Atlantic.


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