Mean BP was 125/80 mm Hg at admission and 133/75 mm Hg at follow-up. Univariate logistic regression analysis showed a significant association between systolic BP in childhood and coronary artery disease at follow-up (odds ratio [OR]=1.052; 95% confidence interval [CI], 1.005-1.101; P=.027). Children with systolic BP at or above the 95th percentile had a 4-fold increase in coronary artery disease at follow-up compared with children whose systolic BP was below the 95th percentile (29% vs 7%, P=.03). Investigators also found an association between elevated BP in childhood and a diagnosis of hypertension at follow-up (P=.007).
Limitations of the study included small sample size, selection bias, changes in the definition of hypertension during the 4 decades since the study began, and limited childhood BP data (a single measurement at admission for surgery).5
Parents of hypertensive children are likely to be hypertensive themselves
Screening BP in children has the potential to identify families at increased risk for cardiovascular disease. A case series found a high incidence of hypertension among the parents of children with elevated BP. Investigators measured several risk factors, including BP in 141 children (mean age 10.5±3.4 years) and 108 parents (at least one a biological parent, mean age 38.5±7.5 years). They obtained 2 BP readings 15 to 30 minutes apart.
Parents of children with BPs at or above the 95th percentile had a 15-fold greater likelihood of hypertension themselves (OR=14.7; 95% CI, 3.02-71.56; P=.009, positive predictive value=75%; negative predictive value=81%).6 Limitations of the study included small sample size, high prevalence of obesity and black ethnicity in the study population (a population with a greater incidence of hypertension), and only 2 BP measurements in the same day, which isn’t diagnostic for hypertension.
Recommendations
The American College of Obstetricians and Gynecologists recommends screening girls for hypertension between 13 and 15 years of age.7
The American Academy of Family Physicians concludes that the evidence is insufficient to recommend for or against routine screening for hypertension in children and adolescents to reduce the risk of cardiovascular disease.8
The European Society of Hypertension and European Society of Cardiology recommend that children older than 3 years have auscultatory BP measurements at each clinic visit.9