Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

How to simplify the diagnostic criteria of hypertension in adolescents

Journal of Human Hypertension volume 25, pages 159–163 (2011)Cite this article

Subjects

Abstract

Diagnosis of hypertension in adolescents is complicated because blood pressure values vary with age, gender and height. How can we simplify the diagnostic criteria for hypertension in adolescents? In 2006, anthropometric measurements were assessed in a cross-sectional population-based study of 3136 Han adolescents aged 13–17 years. Hypertension was defined according to the 2004 National High Blood Pressure Education Program Working Group definition. The following equations for blood pressure-to-height ratio (BPHR) were used: systolic BPHR (SBPHR)=SBP (mm Hg)/height (cm) and diastolic BPHR (DBPHR)=DBP (mm Hg)/height (cm). Receiver-operating characteristic curve analyses were performed to assess the accuracy of SBPHR and DBPHR as diagnostic tests for elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. After the cutoff points were determined, hypertension was defined by SBPHR/DBPHR, and the sensitivity and specificity were calculated. The accuracy of SBPHR and DBPHR (assessed by area under the curve) for identifying elevated SBP and DBP was >0.85 (0.989–1.000). The optimal thresholds of SBPHR/DBPHR for defining hypertension (stages 1 and 2) were 0.75/0.48 for boys and 0.78/0.51 for girls, and for defining hypertension (stage 2) were 0.81/0.57 for boys and 0.84/0.63 for girls. In identifying hypertension, the sensitivity and specificity were both >90% (91.0–99.1%). In identifying stage 2 hypertension, when the sensitivity was 100%, the specificity was 98.6% for boys and 99.1% for girls. BPHR is a simple, accurate and non-age-dependent index for screening hypertension in Han adolescents, especially for stage 2 hypertension.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ . Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004; 113: 475–482.

    Article  PubMed  Google Scholar 

  2. Lauer RM, Clarke WR . Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics 1989; 84: 633–641.

    CAS  PubMed  Google Scholar 

  3. Kiessling SG, McClanahan KK, Omar HA . Obesity, hypertension, and mental health evaluation in adolescents: a comprehensive approach. Int J Adolesc Med Health 2008; 20: 5–15.

    Article  PubMed  Google Scholar 

  4. Berenson GS, Srinivasan SR, Bao W, Newman III WP, Tracy RE, Wattigney WA . Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338: 1650–1656.

    Article  CAS  PubMed  Google Scholar 

  5. Berenson GS . Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa Heart Study. Am J Cardiol 2002; 90: 3L–7L.

    Article  PubMed  Google Scholar 

  6. Hansen ML, Gunn PW, Kaelber DC . Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298: 874–879.

    Article  CAS  PubMed  Google Scholar 

  7. Weili Y, He B, Yao H, Dai J, Cui J, Ge D et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity (Silver Spring) 2007; 15: 748–752.

    Article  Google Scholar 

  8. McCarthy HD, Ashwell M . A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message--‘keep your waist circumference to less than half your height’. Int J Obes (Lond) 2006; 30: 988–992.

    Article  CAS  Google Scholar 

  9. Group of China Obesity Task Force. Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Chin J Epidemiol 2004; 25: 97–102.

    Google Scholar 

  10. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.

    Article  Google Scholar 

  11. Zou KH, O’Malley AJ, Mauri L . Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 2007; 115: 654–657.

    Article  PubMed  Google Scholar 

  12. Rozanov VB, Aleksandov AA, Shugaeva EN, Perova NV, Maslennikova G, Smirnova SG et al. Primary prevention of cardiovascular diseases: long term results of five year long preventive intervention in 12-year old boys (ten year prospective study). Kardiologiia 2007; 47: 60–68.

    CAS  PubMed  Google Scholar 

  13. Luma GB, Spiotta RT . Hypertension in children and adolescents. Am Fam Physician 2006; 73: 1558–1568.

    PubMed  Google Scholar 

  14. Sinaiko AR . Hypertension in children. N Engl J Med 1996; 335: 1968–1973.

    Article  CAS  PubMed  Google Scholar 

  15. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ . Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150: 640–644, e1.

    Article  PubMed  Google Scholar 

  16. Ejike CE, Ugwu CE, Ezeanyika LU, Olayemi AT . Blood pressure patterns in relation to geographic area of residence: a cross-sectional study of adolescents in Kogi state, Nigeria. BMC Public Health 2008; 8: 411.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gutgesell M, Terrell G, Labarthe D . Pediatric blood pressure: ethnic comparisons in a primary care center. Hypertension 1981; 3: 39–47.

    Article  CAS  PubMed  Google Scholar 

  18. Harrabi I, Belarbia A, Gaha R, Essoussi AS, Ghannem H . Epidemiology of hypertension among a population of school children in Sousse, Tunisia. Can J Cardiol 2006; 22: 212–216.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Daniels SR, McMahon RP, Obarzanek E, Waclawiw MA, Similo SL, Biro FM et al. Longitudinal correlates of change in blood pressure in adolescent girls. Hypertension 1998; 31: 97–103.

    Article  CAS  PubMed  Google Scholar 

  20. Rosner B, Prineas RJ, Loggie JM, Daniels SR . Blood pressure nomograms for children and adolescents, by height, sex, and age, in the United States. J Pediatr 1993; 123: 871–886.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China

    Q Lu, C M Ma, F Z Yin, B W Liu, D H Lou & X L Liu

Authors
  1. Q Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C M Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Z Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B W Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D H Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. X L Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F Z Yin.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lu, Q., Ma, C., Yin, F. et al. How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens 25, 159–163 (2011). https://doi.org/10.1038/jhh.2010.46

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2010.46

Keywords

This article is cited by

Search

Advanced search

Quick links