New methods of differentiation between primary and secondary hypertension in a pediatric population: A single-center experience

Rasała, Julia; Marschollek, Paweł; Marschollek, Karol; Ciszewska, Anna; Zwołińska, Danuta; Musiał, Kinga

doi:10.17219/acem/127425

Cited by 5 publications

(7 citation statements)

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“…In a study of 168 hypertensive children conducted in Poland, patients with secondary forms of hypertension had significantly higher mean DBP and DBP loads for all time periods than children with primary hypertension, although the children with secondary hypertension were younger. 57 At the same time, there is uncertainty regarding DBP measurement by ABPM, primarily because most ABPM devices used in pediatrics measure BP by the oscillometric technique, which appears to perform less well for diastolic than SBP in validation studies. 58 In addition, the widely used normative data for pediatric ABPM 35 show a striking lack of variability for DBP according to age and height, which is likely related to the use of the oscillometric technique.…”

Section: Diastolic Hypertensionmentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association

Flynn¹,

Urbina²,

Brady³

et al. 2022

Hypertension

108

189

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Use of ambulatory blood pressure monitoring in children and adolescents has markedly increased since publication of the last American Heart Association scientific statement on pediatric ambulatory blood pressure monitoring in 2014. In addition, there has also been significant expansion of the evidence base for use of ambulatory blood pressure monitoring in the pediatric population, including new data linking ambulatory blood pressure levels with the development of blood pressure–related target organ damage. Last, additional data have recently been published that enable simplification of the classification of pediatric ambulatory monitoring studies. This scientific statement presents a succinct review of this new evidence, guidance on optimal application of ambulatory blood pressure monitoring in the clinical setting, and an updated classification scheme for the interpretation of ambulatory blood pressure monitoring in children and adolescents. We also highlight areas of uncertainty where additional research is needed.

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Section: Diastolic Hypertensionmentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association

Flynn¹,

Urbina²,

Brady³

et al. 2022

Hypertension

108

189

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“…In the 24 studies that defined the specific etiology for each case of secondary hypertension, 77% of secondary cases were due to kidney or renovascular disease (eTable 3 in the Supplement). Three studies included children and adolescents with primary hypertension and secondary hypertension due to kidney disease, but excluded children and adolescents with causes of secondary hypertension not related to kidney disease . There was 1 study with level 1 evidence, 3 studies with level 2 evidence, 19 studies with level 3 evidence, and 7 studies with level 4 evidence (eTable 2 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…Nocturnal systolic blood pressure load of 50% or greater alone was also associated with secondary hypertension (sensitivity, 0.75; specificity, 0.63; LR, 2.0 [95% CI, 1.1-3.6]). Nocturnal diastolic blood pressure load was higher in children and adolescents with secondary hypertension than those with primary hypertension in 1 study 41 ; however, 2 × 2 table data were not available. The absence of nocturnal dipping of systolic and diastolic blood pressure had limited value in detecting secondary hypertension (sensitivity, 0.75; specificity, 0.36; LR, 1.2 [95% CI, 1.0-1.3]).…”

Section: -Hour Ambulatory Blood Pressure Monitoring Resultsmentioning

confidence: 99%

“…Three studies included children and adolescents with primary hypertension and secondary hypertension due to kidney disease, but excluded children and adolescents with causes of secondary hypertension not related to kidney disease. 40,41,51 There was 1 study with level 1 evidence, 3 studies with level 2 evidence, 19 studies with level 3 evidence, and 7 studies with level 4 evidence (eTable 2 in the Supplement). The results of the quality assessment of individual studies appear in eFigure 1 in the Supplement and are summarized across all included studies in eFigure 2 in the Supplement.…”

Section: Study Characteristicsmentioning

confidence: 85%

“…The individual study methods, study populations, inclusion and exclusion criteria, and proportions of children and adolescents with secondary hypertension are described in eTable 2 in the Supplement. Most studies 4,5,[15][16][17][18][19][20][21]23,[35][36][37][38][39][40][41][42] were retrospective cohorts of consecutive children and adolescents referred to pediatric nephrology or pediatric hypertension clinics. Five studies [43][44][45][46][47] were retrospective cohorts of children and adolescents who had 24-hour ambulatory blood pressure monitoring.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Does This Child With High Blood Pressure Have Secondary Hypertension?

Nugent

Jiang

Funaro

et al. 2023

JAMA

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ImportanceGuidelines recommend that all children and adolescents with hypertension undergo evaluation for secondary causes. Identifying clinical factors associated with secondary hypertension may decrease unnecessary testing for those with primary hypertension.ObjectiveTo determine the utility of the clinical history, physical examination, and 24-hour ambulatory blood pressure monitoring for differentiating primary hypertension from secondary hypertension in children and adolescents (aged ≤21 years).Data Sources and Study SelectionThe databases of MEDLINE, PubMed Central, Embase, Web of Science, and Cochrane Library were searched from inception to January 2022 without language limits. Two authors identified studies describing clinical characteristics in children and adolescents with primary and secondary hypertension.Data Extraction and SynthesisFor each clinical finding in each study, a 2 × 2 table was created that included the number of patients with and without the finding who had primary vs secondary hypertension. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.Main Outcomes and MeasuresRandom-effects modeling was used to calculate sensitivity, specificity, and likelihood ratios (LRs).ResultsOf 3254 unique titles and abstracts screened, 30 studies met inclusion criteria for the meta-analysis and 23 (N = 4210 children and adolescents) were used for pooling in the meta-analysis. In the 3 studies conducted at primary care clinics or school-based screening clinics, the prevalence of secondary hypertension was 9.0% (95% CI, 4.5%-15.0%). In the 20 studies conducted at subspecialty clinics, the prevalence of secondary hypertension was 44% (95% CI, 36%-53%). The demographic findings most strongly associated with secondary hypertension were family history of secondary hypertension (sensitivity, 0.46; specificity, 0.90; LR, 4.7 [95% CI, 2.9-7.6]), weight in the 10th percentile or lower for age and sex (sensitivity, 0.27; specificity, 0.94; LR, 4.5 [95% CI, 1.2-18]), history of prematurity (sensitivity range, 0.17-0.33; specificity range, 0.86-0.94; LR range, 2.3-2.8), and age of 6 years or younger (sensitivity range, 0.25-0.36; specificity range, 0.86-0.88; LR range, 2.2-2.6). Laboratory studies most associated with secondary hypertension were microalbuminuria (sensitivity, 0.13; specificity, 0.99; LR, 13 [95% CI, 3.1-53]) and serum uric acid concentration of 5.5 mg/dL or lower (sensitivity range, 0.70-0.73; specificity range, 0.65-0.89; LR range, 2.1-6.3). Increased daytime diastolic blood pressure load combined with increased nocturnal systolic blood pressure load on 24-hour ambulatory blood pressure monitoring was associated with secondary hypertension (sensitivity, 0.40; specificity, 0.82; LR, 4.8 [95% CI, 1.2-20]). Findings associated with a decreased likelihood of secondary hypertension were asymptomatic presentation (LR range, 0.19-0.36), obesity (LR, 0.34 [95% CI, 0.13-0.90]), and family history of any hypertension (LR, 0.42 [95% CI, 0.30-0.57]). Hypertension stage, headache, and left ventricular hypertrophy did not distinguish secondary from primary hypertension.Conclusions and RelevanceFamily history of secondary hypertension, younger age, lower body weight, and increased blood pressure load using 24-hour ambulatory blood pressure monitoring were associated with a higher likelihood of secondary hypertension. No individual sign or symptom definitively differentiates secondary hypertension from primary hypertension.

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Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes

2022

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New methods of differentiation between primary and secondary hypertension in a pediatric population: A single-center experience

Cited by 5 publications

References 0 publications

Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association

Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association

Does This Child With High Blood Pressure Have Secondary Hypertension?

Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes

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