Should we check blood pressures routinely in children?

The Pediatric Insider

© 2013 Roy Benaroch, MD

National guidelines suggest that we check blood pressure at every well check starting at age three. But a recent study calls that wisdom into question. Do we really need to measure blood pressures routinely in children?

In a study published this month, researchers looked at records of over 72,000 children from age 3 through 17. About 8% (6108 children) had an elevated blood pressure during the study—and all of these, as a routine, were told to come in for a repeat measurement within a few weeks. Only 20% returned for a recheck—and of those, only 84 (1.4% of those with an elevated initial BP) actually had a persistently elevated blood pressure.

So: a great majority of elevated blood pressures weren’t even rechecked; and among those that were rechecked, very few remained elevated.  So what’s the point of all of the checking in the first place?

Children often have a mildly elevated BP at the doctor’s office—either from anxiety, or from the cuff size being wrong, or from the fact that kids get kind of worked up sometimes. But if we measure BPs, we really ought to make sure to follow-up on the “abnormal” ones. If we can’t make sure that there’s follow up, or if followup isn’t even necessary, then we shouldn’t be measuring the BP.

The problem as I see it is that the blood pressure tables are set too low in pediatrics. They’re designed, I guess, after the adult blood pressure tables—where a mildly increased blood pressure, over a lifetime, increases long-term disease risk. In pediatrics, we’re looking for a different entity: markedly increased blood pressures that indicate there’s heart or (more likely) kidney disease, right now.

Blood pressures a tad high can probably be ignored—unless there are other indications of long-term cardiovascular risk, like obesity or diabetes. It’s the blood pressures that are really high that really need follow-up. Most pediatricians probably know that, and are hopefully doing that already. But let’s not miss those very few genuinely elevated BPs in the forest of children just a few points high.

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One Comment on “Should we check blood pressures routinely in children?”

  1. Dr. Roy Says:

    It’s official– the USPSTF agrees with me, and does not recommend routine BP screening in kids: http://annals.org/article.aspx?articleid=1747317

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