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  • Letter to the Editor
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Blood pressure reference values for normal-weight children: are they necessary?

International Journal of Obesity volume 39, page 1174 (2015)Cite this article

Subjects

We have read the article by G Barba et al.1 that was recently published in the International Journal of Obesity with great interest. The article proposes reference values for blood pressure deriving from a large sample (16 937 children between 2.0 and 10.9 years) that originated from a multicenter study performed in several European countries. The data collection was performed in a meticulous manner with the use of automatic oscillometric sphygmomanometers. As the obtained blood pressure values are associated not only with height, but also with body weight, the authors eliminated subjects with excess weight from the sample (overweight and obese subjects according to the criteria of the Obesity Task Force) and proposed normal values deriving only from subjects with normal body weight. In the light of the known association between excess weight and elevated blood pressure values, the reference values the authors obtained in this manner are lower, in comparison both with the total sample and with the nomograms proposed by the Fourth Report of the US High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (NHBPEP),2 currently accepted by the Scientific Societies for diagnosing high blood pressure in pediatric age. As the article speaks about ‘updated reference values for blood pressure in children that may be useful for monitoring and planning population strategies for disease prevention’, we would like to bring up a question and share it with the readers of the International Journal of Obesity. Should we, from now on, use these new cutoff values in clinical practice, thereby considering an increasing number of children as having increased blood pressure values compared with the normal values? The measurements were performed by oscillometric sphygmomanometers that have not been validated for the use in pediatric age, and as a consequence it is difficult to use the new normal values for subjects whose blood pressure has been measured with another type of oscillometric device than the one used in the study, which may have a different algorithm, or even with an aneroid or mercury sphygmomanometer. Furthermore, in our opinion, even if the risk of cardiovascular damage is likely to increase with increasing blood pressure, the highest values in a distribution of values observed in a normal population (that is, above the 90th or 95th percentile) do not necessarily amount to the presence of a disease. Regarding the NHBPEP nomograms, over the last years, several evidence has been demonstrating how blood pressure values that exceed the 90th and 95th percentile are related to structural (left ventricular hypertrophy,3 carotid intima-media thickening4), functional (baroreflex impairement5) and metabolic alterations (presence of insulin resistance,6 increase in levels of uric acid,7 changes in some cytokines8). A reduction in reference values obtained by eliminating the contribution of children with excess weight from the sample could cause the risk of not guaranteeing the identification of subjects with blood pressure values that are dangerous for their health, and at the same time cause an unjustified apprehension.

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References

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Authors and Affiliations

  1. Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit, San Gerardo Hospital, Monza, Italy

    S Genovesi

  2. Gruppo di Studio Ipertensione-Società Italiana di Pediatria, Milano, Italy

    M Giussani

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  1. S Genovesi
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  2. M Giussani
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Correspondence to S Genovesi.

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Genovesi, S., Giussani, M. Blood pressure reference values for normal-weight children: are they necessary?. Int J Obes 39, 1174 (2015). https://doi.org/10.1038/ijo.2015.61

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