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Fewer than 4% of children with newly diagnosed hypertension in primary care or school settings have secondary causes
Clinical Question
How often do children with newly diagnosed hypertension have secondary hypertension?
Bottom line
In school or primary care settings, less than 4% of children with newly diagnosed hypertension have secondary causes compared with 20% of those referred to specialty clinics. These data are reassuring that children in primary care settings don't need to undergo extensive work-ups or specialty referrals. 2a
Reference
Study design: Meta-analysis (other)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
These authors searched several databases to identify studies that reported the prevalence of secondary hypertension among children with newly diagnosed hypertension. The authors included 26 studies with 2575 children with hypertension: 19 studies were prospective and 7 were retrospective; 18 studies were in school or primary care settings; and in 8 studies, the participants were referred to nephrology or hypertension clinics. Overall, the studies were at low or moderate risk of bias. Although the approaches to diagnosing secondary hypertension varied, all were acceptable based on current guidelines. Among the participants, 457 (17.7%) were found to have secondary hypertension, but with a high degree of heterogeneity. While the prevalence of secondary hypertension was markedly different by setting (3.7% in school or primary care settings; 20.1% in referral settings), significant heterogeneity remained (78.9% and 94.6%, respectively). The authors found no evidence of publication bias.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Fewer than 4% of children with newly diagnosed hypertension
Of course there is a cause. It is abnormal. Almost certainly metabolic insulin resistance etc. Its part and parcel of the present metabolic obesity epidemic.
children with high bp
less than 4% have secondary causes