BLOOD PRESSURE MEASUREMENT IN CHILDREN AND ADOLESCENTS IN SCHOOL HEALTH SERVICES

Objective: Primary hypertension in children is increasing, yet many cases remain undiagnosed. In Croatia, School Health Services, as part of the annual schedule outlined in the Health Care Measure Plan and Program by the Ministry of Health, provide preventive care for school and university students, including blood pressure (BP) measurements during regular check-ups. Design and method: This study evaluates the frequency of BP measurements in school-aged children and compliance with Croatia’s Health Care Plan. Data from the 2018/19 and 2020/21 school years were analyzed to assess adherence and hypertension diagnosis rates. BP measurements were performed in accordance with the 2016 European Society of Hypertension (ESH) guidelines. Results: In 2018/19, BP was measured at key educational stages. Compliance rates were high in elementary school: 100% in 1st grade (42,735 screenings for 38,839 students), 83.1% in 5th grade (33,423 screenings for 40,235 students), and 97.6% in 8th grade (38,978 screenings for 39,942 students). However, compliance dropped significantly in high school (60.3%, with 23,400 screenings for 38,757 students) and further declined at the university level (12.9%, with 14,819 screenings for 114,681 students). An analysis of annual report data on school health preventive care shows that 17.4% of 583,045 school and university students underwent BP measurements in a single school year: 34.8% of elementary school children, 15.5% of high school students, and 12.9% of university students. Data from 2020/21 show hypertension in 1% of 565,262 screened students: 1.13% of boys and 0.63% of girls in elementary school; 5.26% of boys and 3.13% of girls in high school; and 3.15% of boys and 0.74% of girls at university. Conclusions: BP measurement coverage among children included in the Health Care Plan is high. However, the plan and schedule for BP monitoring do not align with guidelines recommending annual screenings. While compliance is excellent in younger children, it declines significantly with age. Expanding universal BP screening is essential for early hypertension detection and long-term risk reduction. Collaboration between health professionals and policymakers is needed to improve practices.