Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep;40(9):2919-2932.
doi: 10.1007/s00467-025-06716-2. Epub 2025 Mar 31.

Investigations for diagnosis of secondary hypertension in children: yield and costs

Stefano Guarino #  1 , Paola Tirelli #  1 , Anna Di Sessa  1 , Giusy Capasso  1 , Federica Auricchio  1 , Luisa De Angelis  1 , Anna Grandone  1 , Emanuele Miraglia Del Giudice  1 , Pierluigi Marzuillo  2
Affiliations

Investigations for diagnosis of secondary hypertension in children: yield and costs

Stefano Guarino et al. Pediatr Nephrol. 2025 Sep.

Abstract

Background: Screening for secondary hypertension is not recommended for all hypertensive patients, but missing these cases is critical. We aimed to (i) assess hypertension causes in a cohort of hypertensive children, (ii) determine the costs and contributions of an extended diagnostic work-up to screen for secondary hypertension, and (iii) compare the performance of a "short diagnostic work-up" with the protocols of the American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH).

Methods: We conducted a retrospective, single-center study of 70 hypertensive patients aged 1-18 years. All underwent an extended work-up to exclude secondary hypertension. Diagnostic findings, test counts, and costs were analyzed. A short work-up (serum creatinine, fasting glucose, electrolytes, urinalysis, kidney ultrasound (US), and renal artery Doppler US), as well as the AAP and ESH protocols, was evaluated for performance and costs.

Results: Secondary hypertension was identified in 29 patients (41.4%). The extended protocol identified or excluded secondary causes in all patients. Kidney US had the highest diagnostic yield (37.1%). The short work-up and ESH protocol identified all secondary cases, whereas the AAP protocol missed 15 diagnoses. The extended protocol cost € 17,715.60 (€ 253.08 per patient). Direct cost savings were 64.3% with the short work-up, 92.4% with the AAP protocol, and 76.2% with the ESH protocol.

Conclusions: Primary is more common than secondary hypertension in children, with kidney parenchymal disease being the leading secondary cause. As recommended by guidelines, a simplified, focused work-up may offer a cost-effective alternative to extensive screening while maintaining diagnostic accuracy.

Keywords: Children; Costs; Hypertension; Investigations.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: As this study used pre-existing, de-identified data, the Institutional Review Board considered this study exempt. According to Italian law, the Authorization to Process Personal Data for Scientific Research Purposes (Authorization No. 9/2014) declared that retrospective archive studies that use ID codes, preventing the data from being traced back directly to the data subject, do not need ethics approval. Consent to participate: A general written informed consent for the potential use of anonymized retrospective data from clinical charts was obtained from the parents of the patients at the time of their clinical evaluation. Conflict of interest: The authors declare no competing interests.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Causes and risk factors for hypertension. Each segment of the chart indicates the absolute number and percentage of patients with the respective cause or risk factor for hypertension. **Essential hypertension (n = 41, 58.6%): 27 patients with only obesity and 14 with no identified cause or risk factor. PKD, polycystic kidney disease; CAKUT, congenital anomalies of the kidney and urinary tract; CKD, chronic kidney disease; DKD, diabetic kidney disease
Fig. 2
Fig. 2
Performance of the short diagnostic work-up. SCr, serum creatinine; KUS, kidney ultrasound; RAD, Doppler ultrasound of the renal arteries; CSFK, congenital solitary functioning kidney; PKD, polycystic kidney disease; CAKUT, congenital anomalies of the kidney and urinary tract; CKD, chronic kidney disease; DKD, diabetic kidney disease
See this image and copyright information in PMC

References

    1. Flynn JT, Kaelber DC, Baker-Smith CM (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904 - PubMed
    1. Lurbe E, Agabiti-Rosei E, Cruickshank JK et al (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34:1887–1920. 10.1097/HJH.0000000000001039 - PubMed
    1. Italian Data Protection Authority (Garante per la protezione dei dati personali) (2014) Authorisation no. 9/2014-General Authorisation to Process Personal Data for Scientific Research Purposes [3786078]
    1. Flynn JT, Daniels SR, Hayman LL et al (2014) Cardiovascular risk in the pediatric population epidemiology of hypertension update: ambulatory blood pressure monitoring in children and adolescents A Scientific Statement From the American Heart Association AHA Scientific Statement. Hypertension 5:1116–1135. 10.1161/HYP.0000000000000007/-/DC1 - PMC - PubMed
    1. Flynn JT, Urbina EM, Brady TM et al (2022) Ambulatory blood pressure monitoring in children and adolescents: 2022 update: A Scientific Statement from the American Heart Association. Hypertension 79:E114–E124. 10.1161/HYP.0000000000000215 - PMC - PubMed