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Routine blood pressure screening isn't so routine in pediatrics, a national study suggested.

The rate of screening was just 35% in ambulatory pediatric visits overall, Anisha Patel, MD, MSPH, of the University of California San Francisco, and colleagues found.

That rate was particularly low for 3- to 7-year-olds but rose to 84% for preventive visits during which a diagnosis of overweight or obesity was made, the group reported in the October issue of Pediatrics.

"Providers may understand the importance of screening among overweight/obese children; however, efforts to encourage routine screening, particularly in young children, may be needed," they wrote.

Early diagnosis of high blood pressure is key because the condition usually persists into adulthood, leading to cardiovascular disease and end organ damage, the group pointed out.

The growing prevalence of pediatric hypertension has led to universal recommendation for screening, but guidance on how often is less unanimous.

A National Heart, Lung and Blood Institute task force and the American Academy of Pediatrics endorsed an annual blood pressure check for kids over age 3, while the Bright Futures initiative recommends screening for kids over 5 at every visit. The U.S. Preventive Services Task Force has not made a recommendation.

To see what physicians are actually doing, Patel's group examined a nationally-representative sample of outpatient, office, and emergency department visits for children ages 3 to 18 through the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

Over the period from 2000 through 2009, hypertension screening rose in frequency, from 26% of all ambulatory visits in the initial year of analysis to 41% at the end (P<0.0001).

That rate was higher for the 20% of visits that were for preventive care, at 67% overall with a similar rise over time to 71% in 2008-2009.

Significant independent factors predicting blood pressure screening were:

• Older age, with an odds ratio of 2.6 for 13- to 18-year olds and 1.8 for 8- to 12-year-olds compared with 3- to 7-year-olds
• Longer visits, with an odds ratio of 1.3 for those lasting more than 15 minutes
• An overweight or obese diagnosis, with an odds ratio of 2.2

While the relatively high rate of screening for overweight and obese children was appropriate for this "vulnerable population," the group noted that "it is potentially concerning that blood pressure was not measured in nearly one of five of these children."

Another concern was that almost half of the 3- to 7-year-olds didn't undergo screening at preventive care visits.

"Younger children with hypertension are more likely to have underlying pathology and secondary causes for their elevated blood pressures, which underscores the importance of screening in this age group," Patel and colleagues wrote.

Practice setting didn't appear to have much influence, but within office visits, specialists were 60% less likely to screen during preventive care visits than were primary care pediatricians.

Children's gender and race or ethnicity weren't factors after controlling for overweight or obesity.

It was possible that some children got screened without the blood pressure being recorded on the survey tool, the investigators noted.

Also, specific circumstances at some visits may have made blood pressure measurement impractical or not possible, they acknowledged.

The study couldn't determine appropriateness of screening at any given visit or what proportion of patients had their blood pressure screened at least annually.

However, the practice surveys were done over short 1- to 4-week periods in each year, making it unlikely that any patient was seen multiple times, the authors said.

From the American Heart Association:

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