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Blood pressure-to-height ratio for screening prehypertension and hypertension in Chinese children

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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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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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Correspondence to H-J Wang or J Ma.

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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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