An Alternative View of Childhood Blood Pressure Screening: Reframing the Question | Cardiology | JAMA Network Open | JAMA Network
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November 10, 2020

An Alternative View of Childhood Blood Pressure Screening: Reframing the Question

Author Affiliations
  • 1Department of Pediatrics, University of Washington School of Medicine, Seattle
  • 2Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington
JAMA Netw Open. 2020;3(11):e2027964. doi:10.1001/jamanetworkopen.2020.27964

The United States Preventive Services Task Force (USPSTF) has issued an I statement (insufficient evidence) regarding the benefits and harms of childhood blood pressure (BP) screening.1,2 This outcome, which is the same conclusion as their analysis of childhood BP screening in 2013,3 is expected given how the key questions were framed and the analysis performed. However, what is the best approach to assess whether childhood BP measurement is associated with adult cardiovascular disease (CVD) or whether treatment of high BP in childhood is associated with reducing the burden of adult CVD? The best evidence to address these questions would be randomized clinical trials comparing screening vs no screening and treatment vs no treatment. Given the recommendations of the American Academy of Pediatrics (AAP),4 European Society of Hypertension,5 and other organizations that screening BP measurement should be performed and persistent hypertension treated in children and adolescents, clinical trials that directly address these questions are likely infeasible. The required length of follow-up, likely 5 or 6 decades, is an additional barrier. The questions must be reframed.

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