Comparison among Different Screening Tests for Diagnosis of Adolescent Hypertension

The diagnosis of childhood hypertension based upon percentile tables proposed by the international guidelines is complex and often a cause of underdiagnosis, particularly among physicians who have not had specific training in the field of adolescent hypertension. The use of a simple and accurate screening test may improve hypertension diagnosis in adolescents. The aim of our study is to compare the different screening methods currently used in the literature to improve the diagnosis of childhood hypertension. We have conducted a cross-sectional population-based study of 1412 Caucasian adolescents among students of public junior high schools of Turin, Italy. In this population we have defined the hypertensive status with four different screening tests: BPHR, Somu's equations, Ardissino, and Kaelber methods. Finally, we compared the diagnostic accuracy of the 4 screening tests with the gold standard. Our analysis identifies in BPHR the test which combines ease of use and diagnostic accuracy. 1. Introduction Prevalence of childhood hypertension is constantly rising [1]; early detection is therefore important in order to reduce progression of adult hypertension, premature development of organ damage and to establish early treatment of all associated risk factors. In adolescents blood pressure values vary with height, age, and gender, making it impossible to utilize a specific blood pressure level to define hypertension, as in adults. The identification of blood pressure thresholds for any child implies the use of sex-specific height percentiles tables and subsequently tables specifying systolic and diastolic 90th and 95th percentiles for different sex, age, and height percentiles. Children with average of systolic or diastolic blood pressure ≥90th and <95th percentiles are classified as having high-normal blood pressure; hypertension is defined when systolic and/or diastolic blood pressure are persistently ≥95th percentile [2]. The practical complexity of this method is an essential cause of underdiagnosis for this condition. Throughout the years, different criteria have been suggested in order to simplify diagnosis and therefore reduce under-diagnosis. 2. Aim We have looked for the different screening tests currently used in the literature in order to compare their accuracy in the diagnosis of hypertension in adolescents. The aim of our study is to propose a critical analysis and a comparison among different screening methods currently available in order to find the simplest and most accurate one. 3. Methods We have conducted a cross-sectional