Hypertensive adolescents detected by a school surveillance programme: a problem of obesity

BP has been measured in secondary school children in Nottingham as part of a routine health appraisal since 1988. School nurses who have received appropriate training refer children with a BP greater than the 95th centile for age and sex (Task Force USA 1987) initially to a community paediatrician or general practitioner. Of 14,570 children checked, only 23 patients (14 female) with a mean age of 13.9 years (range 10-15.8 years) were referred to a paediatric nephrology clinic to be seen in consultation with a dietitian. In 12 of 23 children there was a family history of hypertension and in seven a family history of other cardiovascular disease. No patient with secondary hypertension was identified; 14 patients (61%) were overweight or obese (nine) on the basis of percentage weight for height at the time of referral. BP values have tended to normalise on follow-up. Although six of 22 patients lost weight with dietetic support, eight patients gained weight. The school surveillance programme for BP is felt by the school nurses to be a valuable health educational tool and has resulted in few hospital referrals. Although initial dietetic advice may be of value, obesity remains a significant problem for the majority of adolescents in this group.