Poor Concordance Between Elevated Blood Pressures in the Preschool Years

Area of Science:

• Pediatrics
• Cardiology
• Preventive Medicine

Background:

• The US Preventive Services Task Force (USPSTF) found insufficient evidence for routine pediatric blood pressure screening in 2013.
• Hypertension in children is a growing concern, necessitating reliable screening methods.

Purpose of the Study:

• To evaluate the reliability and predictive value of successive annual blood pressure screening in preschool-aged children.
• To determine if elevated blood pressure readings at 3, 4, or 5 years old correlate with future hypertension.

Main Methods:

• Retrospective study analyzing blood pressure data from 328 children's health maintenance visits between January 1, 2010, and June 18, 2014.
• Assessed blood pressure measurements at 3, 4, and 5 years old using extended concordance correlation coefficients and kappa statistics.

Main Results:

• 88% of children (290/328) were normotensive across all three annual visits.
• All elevated blood pressures were Stage 1; no child met criteria for hypertension (3 elevated measures).
• Poor agreement was found for systolic (0.19) and diastolic (0.11) measurements, with no significant association between readings at different time points (kappa values near zero).

Conclusions:

• Annual blood pressure screening in preschool years demonstrates poor reliability for identifying children at risk of developing hypertension.
• Stage 1 elevated blood pressures in this age group do not reliably correlate with hypertension.
• Watchful waiting and parental reassurance may be more appropriate management strategies for transiently elevated preschooler blood pressures.