May 18, 2020
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support the United States Preventive Services Task Force’s efforts to update the 2013 recommendations on screening for high blood pressure in children and adolescents, based on more recent research. We agree that screenings should not be recommended without sufficient evidence that it helps prevent negative health outcomes. Unfortunately, there is insufficient evidence regarding the long-term effectiveness of interventions or that interventions in childhood reduce adverse outcomes in adulthood.
In addition to lack of evidence of benefits of screening for either reducing adverse health outcomes related to hypertension or delaying its onset, there is lack of evidence regarding the potential harms of screening and interventions in a general population. Even if there was better evidence of benefits, there is a risk that screening may produce false positives, which would lead to children receiving treatment that they do not actually need. Potentially, some of these unnecessary treatments could even lead to adverse effects in children.
For example, one recent meta-analysis assessing pharmacological treatments for childhood hypertension revealed that there is insufficient evidence to fully assess the potential harms and long-term benefits of such treatment. The researchers concluded that the studies had a median follow-up of only 35 days. The short follow-up time makes it impossible to know the long-term benefits or risks of these treatments. Moreover, there is a lack of information regarding potential adverse effects of pharmacological treatments in the short-term or long-term.
Given the lack of evidence and the unknown risks of potential harms, we support caution in providing a recommendation regarding screening.
National Center for Health Research can be reached at firstname.lastname@example.org or at (202) 223-4000.
1. Burrello J, Erhardt EM, Saint-Hilary G, Veglio F, Rabbia F, Mulatero P, Monticone S, D’Ascenzo F. Pharmacological treatment of arterial hypertension in children and adolescents: a network meta-analysis. Hypertension. 2018; 72(2):306-13.