JAMA Pediatrics: Nephrology Topic Collection

Screening for Elevated Blood Pressure in Children and Adolescents A Critical Appraisal Elevated BP in Children and Adolescents

Chiolero A, Bovet P, Paradis G. — Fri, 01 Mar 2013 00:00:00 GMT

Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. 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.

Blood Pressure Screening in Children and Adolescents Is the Glass Half Empty or More Than Half Full? Child and Adolescent Blood Pressure Screening

Daniels SR, Gidding SS. — Fri, 01 Mar 2013 00:00:00 GMT

Hypertension is prevalent in adults and a potent risk factor for cardiovascular disease. Hypertension is present in 33.5% of adult men and women and a risk factor for myocardial infarction, stroke, renal disease, and congestive heart failure. In adults, only 48% of those aware that they have hypertension have their condition controlled. Since 1977, the National Heart, Lung, and Blood Institute (NHLBI) has recommended routine measurement of blood pressure in children starting at age 3 years. This recommendation has been adopted by the American Academy of Pediatrics and incorporated into Bright Futures, their recommended approach to childhood preventive care.

Picture of the Month—Quiz Case

Lee C, White AJ. — Fri, 01 Mar 2013 00:00:00 GMT

A 12-year-old boy presented with painful hands and flexible wrists, which were first noticed at 3 years of age. He had no other medical or family history, but he had undergone several bilateral operations on his feet for the correction of deformities. His wrists were particularly painful, and he complained of them being “too bendy.” A physical examination determined that the boy had shortened feet with metatarsal adductus, pes planus, a decreased range of motion of the midfoot joints, and multiple surgical scars. The length and width of his fingers appeared normal, but the metacarpus appeared small. Wrist instability was present with a dramatically increased range of motion (Figure, A). Redundant tissue was present over the dorsum of his hands, with apparently normal elasticity. There were no vascular anomalies or abnormal-appearing scars; the skin itself appeared normal. He wore glasses but had no lens dislocation. His corneas were not cloudy, and the sclera were not blue. His lungs were clear, and the heart sounds were without murmur. The patient had an abnormal gait due to foot deformities and surgical scars, but he was able to ambulate without mechanical assistance. The remainder of his physical examination was unremarkable. The patient had no hypertension, and a urinalysis showed that there was no hematuria or proteinuria.