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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Flynn JT. An Alternative View of Childhood Blood Pressure Screening: Reframing the Question. JAMA Netw Open. 2020;3(11):e2027964. doi:10.1001/jamanetworkopen.2020.27964
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: