Poor Concordance Between Elevated Blood Pressures in the Preschool Years

The 2013 US Preventive Services Task Force report found insufficient evidence for pediatric blood pressure screening. This retrospective study evaluated the reliability of successive annual blood pressure screening of children for hypertension at the 3-, 4-, and 5-year-old health maintenance visits (January 1, 2010 to June 18, 2014). Of 328 patients, 290 (88%) were normotensive at all 3 visits. All elevated blood pressures (≥95th percentile) were stage 1. No patient was hypertensive (3 elevated measures). The extended concordance correlation coefficient indicated poor agreement for systolic (0.19, 95% CI -0.49 to 0.72) and diastolic (0.11, 95% CI -0.39 to 0.56) measurements. Blood pressure at the 3-year (κ -0.008, 95% CI -0.11 to 0.09), 4-year (κ 0.09, 95% CI -0.06 to 0.24), or 5-year (κ 0.08, 95% CI -0.05 to 0.20) visit was not associated with elevated blood pressures at the other 2 time points. In the preschool years, stage 1 elevated blood pressures do not correlate with hypertension and may be better managed by watchful waiting and parental reassurance.