Key result
Using solely the second blood pressure reading at an initial screening visit demonstrated strong discrimination (AUC 0.93) for identifying hypertension in children, comparable to the reference method.
Why the study?
Hypertension screening in children typically involves several blood pressure readings at an initial visit, but there is no recommendation on the minimum number of readings required.
Does obtaining two BP readings and using only the second one at an initial screening visit accurately predict the diagnosis of hypertension in children?
Observational (n=5,207)
Yes
Does obtaining two BP readings and using only the second one at an initial screening visit accurately predict the diagnosis of hypertension in children?
Absolute Event Rate: 0.93% vs 0.95%
Obtaining two blood pressure readings and using only the second one at an initial screening visit may be sufficient to accurately identify hypertension in children, reducing the burden of multiple measurements.
Low prevalence limits screening yield in children; leaves open validation of R2 thresholds before wider adoption.
Hypertension in children is defined as sustained elevated blood pressure (BP) over several visits. For the screening of hypertension, it is standard to obtain several BP readings at the initial visit. There is however no recommendation on the minimum number of readings needed. We evaluated the performance of BP readings obtained at one initial screening visit to predict the diagnosis of hypertension in children. In a school-based study conducted in Switzerland, BP was measured three times on up to three visits in 5207 children. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of elevated BP at the initial screening visit for the identification of hypertension were estimated using the 1st, 2nd, and 3rd BP readings (R1, R2, R3), as well as (R1 + R2)/2 and (R1 + R2 + R3)/3). These performance indices were compared with the reference method (R2 + R3)/2. The ability of BP readings to discriminate children with and without hypertension was evaluated with receiver operating characteristic curve analysis. The prevalence of systolic/diastolic hypertension was 2.2%. The greatest performance to identify children with hypertension was obtained with R2 (sensitivity: 97%; specificity: 88%; PPV: 15%; NPV: 100%) and the reference method, (R2 + R3)/2 (sensitivity: 100%; specificity: 90%; PPV: 18%; NPV: 100%). The ability to discriminate using R1, R2, (R1 + R2)/2, and (R2 + R3)/2 for the identification of hypertension was strong (AUC: 0.89, 0.93, 0.92, and 0.95, respectively). Obtaining two BP readings and using only the second one at a screening visit may be sufficient as initial step for the identification of hypertension in children.
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Outdili et al. (2019) conducted an observational in Hypertension (n=5,207). Second blood pressure reading (R2) vs. Average of second and third readings ((R2 + R3)/2) was evaluated on Area under the ROC curve (AUC) for identification of systolic/diastolic hypertension. Using solely the second blood pressure reading at an initial screening visit demonstrated strong discrimination (AUC 0.93) for identifying hypertension in children, comparable to the reference method.
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