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Investigations for diagnosis of secondary hypertension in children: yield and costs

Stefano Guarino1, Paola Tirelli1, Anna Di Sessa1

  • 1Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.

Pediatric Nephrology (Berlin, Germany)
|March 31, 2025
PubMed

Insights

A focused diagnostic work-up effectively screens for secondary hypertension in children, identifying kidney disease as a common cause. This approach is more cost-effective than extensive screening, ensuring accurate diagnoses.

Area of Science:

  • Pediatric Nephrology
  • Cardiology
  • Clinical Diagnostics

Background:

  • Screening for secondary hypertension in children is crucial, though not universally recommended.
  • Identifying secondary causes of hypertension is critical to prevent long-term complications.
  • Current diagnostic protocols vary, necessitating evaluation of their effectiveness and cost.

Purpose of the Study:

  • To assess the causes of hypertension in a cohort of pediatric patients.
  • To determine the costs and diagnostic contributions of an extended work-up for secondary hypertension.
  • To compare the performance and costs of a "short diagnostic work-up" against established American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH) protocols.

Main Methods:

  • A retrospective, single-center study involving 70 hypertensive children (aged 1-18 years).
  • All patients underwent an extended diagnostic work-up to identify secondary hypertension causes.
  • Performance and costs of a short work-up (including kidney ultrasound and Doppler) were compared with AAP and ESH guidelines.

Main Results:

  • Secondary hypertension was identified in 41.4% of patients, with kidney parenchymal disease being the most frequent cause.
  • A short work-up and the ESH protocol successfully identified all secondary hypertension cases.
  • The AAP protocol missed 15 diagnoses, while the extended protocol incurred significant costs (€253.08 per patient).

Conclusions:

  • Primary hypertension is more prevalent than secondary hypertension in children.
  • A simplified, focused diagnostic work-up is a cost-effective strategy for screening secondary hypertension in pediatric patients.
  • Kidney parenchymal disease is the leading secondary cause of hypertension in children, highlighting the importance of renal evaluation.
Abstract

Keywords:
ChildrenCostsHypertensionInvestigations

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