Skip to navigation bar Skip to breadcrumbs Skip to page content Skip to comments area
clear place holder
Envelope icon E-mail Updates Teal square Text size:  a A A
You are here: HomePublic Comments and NominationsOpportunity for Public CommentDraft Research Plan : Draft Research Plan

Draft Research Plan

Draft Research Plan for Hypertension in Children and Adolescents: Screening

This opportunity for public comment expired on July 25, 2018 at 8:00 PM EST

Note: This is a Draft Research Plan. This draft is distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF. The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Send Us Your Comments

In an effort to maintain a high level of transparency in our methods, we open our draft Research Plans to a public comment period before we publish the final version.

Comment period is not open at this time.

Draft: Proposed Analytic Framework

This figure is an analytic framework depicting the key questions (KQs) within the context of the populations, interventions, comparisons, outcomes, time frames, and settings (PICOTS) relative to the effectiveness and harms for screening and treatment of elevated blood pressure in children and adolescents. KQ1 concerns the relationship between screening and reduced adverse health outcomes related to hypertension. The population is shown as asymptomatic children and adolescents who undergo a screening test with unknown diagnostic accuracy (KQ2). For the entire population, the harms of screening are examined (KQ3). The pathway indicates that populations with elevated blood pressure have a diagnostic workup followed by diagnosis of primary or secondary hypertension. A pathway from hypertension leads to examining the association between hypertension in children and adolescents and other intermediate outcomes in adults (KQ4). If the population has hypertension, they continue to treatment (KQ5). For those receiving treatment, the harms of treatment are examined (KQ8). A pathway from treatment of hypertension in children and adolescents leads to other intermediate outcomes in adults (KQ6). Finally, the outcome of reduced adverse health outcomes is depicted (KQ7).

*Intermediate outcomes include left ventricular hypertrophy, urinary albumin excretion (microalbuminuria), intima media thickness (measured at the carotid, femoral, or both arteries), and retinal vascular changes.

Draft: Proposed Key Questions to Be Systematically Reviewed

  1. Does screening for hypertension in children and adolescents delay the onset of or reduce adverse health outcomes related to hypertension?
  2. What is the diagnostic accuracy of screening tests for elevated blood pressure in children and adolescents?
  3. What are the adverse effects of screening for hypertension in children and adolescents, including labeling and anxiety?
  4. What is the association between primary hypertension in children and adolescents and hypertension and other intermediate outcomes in adults?
  5. What are the effectiveness of drug, nondrug, and combination interventions for treating hypertension in children and adolescents?
  6. What are the effectiveness of drug, nondrug, and combination interventions initiated for the treatment of hypertension in children and adolescents for reducing blood pressure and improving other intermediate outcomes in adults?
  7. What are the effectiveness of drug, nondrug, and combination interventions initiated for the treatment of primary hypertension in children and adolescents for reducing adverse health outcomes related to primary hypertension in adults?
  8. What are the adverse effects of drug, nondrug, and combination interventions for treating primary hypertension in children and adolescents?

Draft: Proposed Contextual Questions

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. What is the prevalence of primary and secondary hypertension in asymptomatic children and adolescents in primary care settings?
  2. What are the optimal ages at which to start screening for hypertension and the optimal time intervals at which to repeat screening in children and adolescents?
  3. What are the effectiveness and adverse effects of drug, nondrug, and combination interventions for treating the underlying conditions of secondary hypertension in children and adolescents?

Draft: Proposed Research Approach

The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

  Included Excluded
Populations KQs 1–3: Asymptomatic, otherwise healthy children and adolescents ages 1–18 years, with no known diagnosis of hypertension

KQs 4–8: Studies in which all participants have hypertension or persistently elevated blood pressure*

Pregnant adolescents
Interventions KQs 1, 3: Screening for elevated blood pressure with three separate measurements, using auscultatory or oscillometric devices (based on established normative thresholds)

KQ 2: Index test consisting of three separate blood pressure measurements, using auscultatory or oscillometric devices (based on established normative thresholds)

KQs 5–8:

  • Antihypertension medications that are currently approved by the U.S. Food and Drug Administration for use in children, adolescents, or both
  • Lifestyle modifications, including diet and exercise
  • Combinations of drug and lifestyle interventions
KQs 1, 3:
  • Screening that cannot be implemented in primary care settings
  • Screening with fewer than three separate blood pressure measurements

KQ 2:

  • Diagnostic tests not used for screening in primary care settings
  • Diagnostic tests with fewer than three separate blood pressure measurements

KQs 5–8:

  • Interventions that treat underlying causes of secondary hypertension (these interventions will be addressed in Contextual Question 3)
  • Interventions for which treatment of hypertension is not the primary objective of the study (i.e., diet and physical activity interventions for weight loss or prevention of weight gain); interventions for the primary prevention of hypertension
Comparator KQs 1, 3: No screening

KQ 2: Clinically confirmed diagnosis of hypertension after diagnostic workup (e.g., 24-hour or ambulatory blood pressure measurements)

KQs 5–8: Placebo, delayed intervention, or other inactive interventions

KQ 2: Any reference test not specified in the inclusion criteria; studies with no reference test

KQs 5–8: Active interventions or usual care

Outcomes KQs 1, 7: Hypertension-related outcomes for:
  • Severe visual impairment
  • End-stage renal disease
  • Cardiovascular events, including ischemic heart disease and heart failure
  • Cerebrovascular events, including hemorrhagic and thrombotic stroke and hypertensive encephalopathy
  • Mortality (all-cause and disease-specific [renal disease, cardiovascular disease])

KQ 2: Measures of test accuracy (e.g., positive and negative predictive value, likelihood ratios, sensitivity, specificity, receiver operating characteristic curves)

KQ 3: Labeling, anxiety, and school absenteeism

KQ 4: Predictive and prognostic validity (e.g., positive and negative predictive value, likelihood ratios, sensitivity, specificity); measures of association (e.g., odds ratio, risk ratio, correlation or regression coefficient)

KQs 5, 6:

  • Blood pressure
  • Left ventricular hypertrophy (defined using left ventricular mass index, measures of left ventricular geometry, or both)
  • Urinary albumin excretion (microalbuminuria)
  • Intima media thickness (measured at carotid, femoral, or both arteries)
  • Retinal vascular changes
KQ 8: Harms of drug and nondrug interventions for hypertension
KQ 2:
  • Correlation
  • Studies that do not provide enough data to recreate 2x2 tables to calculate sensitivity and specificity

KQs 5, 6:

  • Measures of cognitive function
  • Blood pressure variability, such as diurnal variation, or nocturnal blood pressure dipping
  • Arterial wall dysfunction, including measures of arterial stiffness, pulse wave velocity, and augmentation index
  • Metabolic measures, namely glucose tolerance or other measures of impaired glucose tolerance, insulin level, lipid profile, and homocysteine level
  • Uric acid level
  • Inflammatory markers, including C-reactive protein
  • Changes in weight or body mass index
Settings KQs 1, 3: Primary care clinics, well-child/adolescent visits, or ambulatory settings; school- or community-based screening

KQs 5–8: Pediatric and family practices, pediatric specialty/subspecialty clinics, inpatient or long-term care settings, emergency or urgent care facilities, or ambulatory settings; school- or community-based treatment

KQ 4: All settings
KQs 1–3: Pediatric specialty/subspecialty clinics; emergency or urgent care facilities

KQs 5–8: Settings that are not comparable to or referable from primary care

Study designs KQ 1: Randomized controlled trials, controlled clinical trials, observational studies with a comparison group (e.g., comparative cohort and case-control studies), and systematic reviews

KQ 2: Studies of diagnostic test accuracy

KQ 4: Longitudinal cohort studies

KQs 3, 8: Randomized controlled trials, controlled clinical trials, observational studies with a comparison group (e.g., large [sample size >1,000] cohort and case-control studies), and systematic reviews; if none identified, will accept uncontrolled before-after studies

KQs 5–7: Randomized controlled trials, controlled clinical trials, observational studies with a comparison group (e.g., large [sample size >1,000] cohort and case-control studies), and systematic reviews
 

*Definitions may vary based on prevalent guidelines at the time of the study.

Current as of: June 2018

Internet Citation: Draft Research Plan: Hypertension in Children and Adolescents: Screening. U.S. Preventive Services Task Force. June 2018.
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-research-plan/hypertension-in-children-and-adolescents-screening1

USPSTF Program Office   5600 Fishers Lane, Mail Stop 06E53A, Rockville, MD 20857