1st BP screening correctly diagnoses hypertension in less than half of children

An action as simple as double-checking a child’s blood pressure during a routine pediatric visit could save thousands of dollars and misdiagnoses, researchers reported this month in the Journal of Clinical Hypertension.

Current pediatric practice guidelines recommend dual blood pressure (BP) screenings during a child’s visit, because anxiety, stress and measurement error can lead to an increased likelihood of misreadings the first time around, first author Corinna Koebnick, PhD, and colleagues wrote. Still, most clinicians aren’t adhering to that suggestion, instead opting to schedule a follow-up appointment with the nearly 25 percent of kids who record higher-than-average readings.

If a child were to be diagnosed based on her or his first blood pressure screening, Koebnick et al. wrote, less than half of their research team’s 186,732-strong study population would be correctly classified as hypertensive.

“While routine medical visits offer a good opportunity to screen for high BP in asymptomatic youth, the adherence to current BP screening guidelines is poor,” the authors wrote in Clinical Hypertension. “When BP is measured, hypertension is often overlooked and underdiagnosed in pediatric populations until they transition to adult care.”

And hypertensive children are, according to prior research, two to three times more likely to develop essential hypertension in young adulthood, which also leads to a boosted risk of cardiovascular disease later in life.

Koebnick and co-authors evaluated the misclassification of pediatric patients as hypertensive in their study, comparing eventual diagnoses with a child’s first BP screening results.

They found that in patients with an initial BP reading above the 95th percentile led to a false diagnosis of hypertension in 54.1 percent of children who required follow-up visits, according to the study. Just 2.3 percent and 11.3 percent of children who went attended those follow-ups sustained a diagnosis of stage I or stage II hypertension, respectively.

“Our findings suggest that a high initial BP reading in youth is common, while the proportion of youth with sustained hypertension is low,” Koebnick and colleagues said. “Only approximately half of the pediatric patients would be correctly classified based on their initial BP. The recommendation to repeat high BP during the same visit needs to be emphasized because it saves unnecessary follow-up visits.”