Abstract
The diagnosis of hypertension in children is complicated because of the multiple age-, sex- and height-specific thresholds. To simplify the process of diagnosis, blood pressure-to-height ratio (BPHR) was employed in this study. Data were obtained from a Chinese national survey conducted in 2010, and 197 191 children aged 7–17 years were included. High normal and elevated blood pressure (BP) were defined according to the National High Blood Pressure Education Program (NHBPEP) Working Group definition. The optimal thresholds were selected by Youden’s index. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and area under the curve (AUC) were assessed for the performance of these thresholds. The systolic and diastolic BPHR thresholds for identifying high normal BP were 0.84/0.55, 0.78/0.50 and 0.75/0.46 for children aged 7–8 years, 9–11 years and 12–17 years, respectively. The corresponding thresholds for identifying elevated BP were 0.87/0.57, 0.81/0.53 and 0.76/0.49, respectively. These proposed thresholds revealed high sensitivity and NPVs, all above 0.96, moderate to high specificity and AUCs, and low PPVs. Our finding suggested the proposed BPHR thresholds were accurate for identifying children without high normal or elevated BP, and could be employed to simplify the procedure of screening prehypertension and hypertension in children.
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References
WHO Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization: Geneva, 2009.
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.
McCrindle BW . Assessment and management of hypertension in children and adolescents. Nat Rev Cardiol 2010; 7: 155–163.
Chen X, Wang Y . Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008; 117: 3171–3180.
Chiolero A, Bovet P, Paradis G . Screening for elevated blood pressure in children and adolescents: a critical appraisal. JAMA Pediatr 2013; 167: 266–273.
Hansen ML, Gunn PW, Kaelber DC . Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298: 874–879.
Redwine KM, Falkner B . Progression of prehypertension to hypertension in adolescents. Curr Hypertens Rep 2012; 14: 619–625.
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.
Moyer VA . Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Pediatrics 2013; 132: 907–914.
Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LM . Hypertension screening using blood pressure to height ratio. Pediatrics 2014; 134: e106.
Liang YJ, Xi B, Hu YH, Wang C, Liu JT, Yan YK et al. Trends in blood pressure and hypertension among Chinese children and adolescents: China Health and Nutrition Surveys 1991–2004. Blood Press 2010; 20: 45–53.
Dong B, Wang HJ, Wang Z, Liu JS, Ma J . Trends in blood pressure and body mass index among Chinese children and adolescents from 2005 to 2010. Am J Hypertens 2013; 26: 997–1004.
Bijlsma MW, Blufpand HN, Kaspers GJ, Bokenkamp A . Why pediatricians fail to diagnose hypertension: a multicenter survey. J Pediatr 2014; 164: 173–177.
Lu Q, Ma CM, Yin FZ, Liu BW, Lou DH, Liu XL . How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens 2011; 25: 159–163.
Outdili Z, Marti-Soler H, Simonetti GD, Bovet P, Paccaud F, Burnier M et al. Performance of blood pressure-to-height ratio at a single screening visit for the identification of hypertension in children. J Hypertens 2014; 32: 1068–1074.
Ji CY, Chen TJ . Secular changes in stature and body mass index for Chinese youth in sixteen major cities, 1950 s–2005. Am J Hum Biol 2008; 20: 530–537.
Guo X, Zheng L, Li Y, Zhang X, Yu S, Sun Y . Blood pressure to height ratio: A novel method for detecting hypertension in paediatric age groups. Paediatr Child health 2013; 18: 65–69.
Kelishadi R, Heshmat R, Ardalan G, Qorbani M, Taslimi M, Poursafa P et al. First report on simplified diagnostic criteria for pre-hypertensionand hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study. J Pediatr (Rio J) 2014; 90: 85–91.
Rabbia F, Rabbone I, Totaro S, Testa E, Covella M, Berra E et al. Evaluation of blood pressure/height ratio as an index to simplify diagnostic criteria of hypertension in Caucasian adolescents. J Hum Hypertens 2011; 25: 623–624.
Galescu O, George M, Basetty S, Predescu I, AnilMongia S, Ten S et al. Blood pressure over height ratios: simple and accurate method of detecting elevated blood pressure in children. Int J Pediatr 2012; 2012: 253497.
Ji CY, Chen TJ . Empirical changes in the prevalence of overweight and obesity among Chinese students from 1985 to 2010 and corresponding preventive strategies. Biomed Environ Sci 2013; 26: 1–12.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240.
Cole TJ, Flegal KM, Nicholls D, Jackson AA . Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007; 335: 194.
Sedgwick P . Receiver operating characteristic curves. BMJ 2013; 346: f2493.
Zou KH, O'Malley AJ, Mauri L . Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 2007; 115: 654–657.
Acknowledgements
We would like to thank the members of CNSSCH for providing access to the survey data. We also appreciate all the students who participated in the survey for their cooperation. This work is supported by the grant from National Health and Medical Research Council of Australia (ZW, grant number APP1045000), Specialized Research Fund for the Doctoral Program of Higher Education of China (JM, grant number 20120001110016) and Research Special Fund for Public Welfare Industry of Health, China (JM, grant number 201202010).
Author Contributions
BD and ZW formulated the research questions and designed the study; JM and H-JW acquired the data; BD wrote the manuscript; and all authors conducted the statistical analysis, interpreted data, revised the manuscript critically for important intellectual content, and approved the final version of the manuscript.
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Dong, B., Wang, Z., Wang, HJ. et al. Blood pressure-to-height ratio for screening prehypertension and hypertension in Chinese children. J Hum Hypertens 29, 618–622 (2015). https://doi.org/10.1038/jhh.2014.133
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DOI: https://doi.org/10.1038/jhh.2014.133
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