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:

Preschool children blood pressure percentiles by age and height

Journal of Human Hypertension volume 31, pages 400–408 (2017)Cite this article

Subjects

Abstract

We aimed to construct blood pressure (BP) references for the Polish preschool children and to compare them with the United States, German and European references. BP was measured oscillometrically using a validated device in 4378 randomly selected Polish children aged 3–6 years who were free of chronic diseases and behaved quietly during BP measurement. Height and weight were also measured. Gender-specific BP percentiles were constructed for age and height simultaneously with the use of quantile regression and a polynomial regression model. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure reference percentiles by gender, age and height are presented. The Polish preschool children’s 90th and 95th SBP and DBP percentiles were mostly lower than those in the United States, German and IDEFICS study BP references. Compared with the German oscillometric BP reference and with the United States sphygmomanometric BP reference, differences in the 95th SBP percentiles ranged by age from −5 to 0 mm Hg and from −2 to −1 mm Hg, in boys and girls, respectively, whereas the differences in the 95th percentiles of DBP ranged from −7 to −1 mm Hg and from −5 to −1 mm Hg, in boys and girls, respectively. Polish preschool children’s BP percentiles based on measurements with the use of a validated oscillometric device in a nationally representative sample are lower than those from the current United States, German and European references. When interpreting BP measurements in children, adequate referential values should be used.

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

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. 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 

  2. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C et al. European Society of Hypertension. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 2009; 27: 1719–1742.

    Article  CAS  Google Scholar 

  3. Chen X, Wang Y . Tracking of blood pressure from childhood to adulthood: a systematic review and meta–regression analysis. Circulation 2008; 117: 3171–3180.

    Article  Google Scholar 

  4. Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR . Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics 2007; 119: 237–246.

    Article  Google Scholar 

  5. Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A et al. Left ventricular hypertrophy and arterial wall thickening in children with essentials hypertension. Pediatr Nephrol 2006; 21: 811–819.

    Article  Google Scholar 

  6. Krzyzaniak A, Krzywińska-Wiewiorowska M, Stawińska-Witoszyńska B, Kaczmarek M, Krzych L, Kowalska M et al. Blood pressure references for Polish children and adolescents. Eur J Pediatr 2009; 168: 1335–1342.

    Article  Google Scholar 

  7. Kułaga Z, Litwin M, Grajda A, Kułaga K, Gurzkowska B, Góźdź M et al. Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents. J Hypertens 2012; 30: 1942–1954.

    Article  Google Scholar 

  8. Guo SS, Roche AF, Chumlea WC, Johnson C, Kuczmarski RJ, Curtin R . Statistical effects of varying sample sizes on the precision of percentile estimates. Am J Hum Biol 2000; 12: 64–74.

    Article  Google Scholar 

  9. Wong SN, Tz Sung RY, Leung LC . Validation of three oscillometric blood pressure devices against auscultatory mercury sphygmomanometer in children. Blood Press Monit 2006; 11: 281–291.

    Article  Google Scholar 

  10. Kułaga Z, Grajda A, Gurzkowska B, Góźdź M, Wojtyło M, Swiąder A et al. Polish 2012 growth references for preschool children. Eur J Pediatr 2013; 172: 753–761.

    Article  Google Scholar 

  11. Cole TJ, Bellizzi MC, Flegal K, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  12. Pan H, Cole TJ . LMSgrowth, a Microsoft Excel add-in to access growth references based on the LMS method. Version 2.69. Available at http://www.healthforallchildren.co.uk.

  13. Munkhaugen J, Lydersen S, Widerøe TE, Hallan S . Blood pressure reference values in adolescents: methodological aspects and suggestion for Northern Europe tables based in the Nord-TrØndelag Health Study II. J Hypertens 2008; 26: 1912–1918.

    Article  CAS  Google Scholar 

  14. Lew M . Good statistical practice in pharmacology. Problem 1. Br J Pharmacol 2007; 152: 295–298.

    Article  CAS  Google Scholar 

  15. Koenker R, Bassett G . Regression quantiles. Econometrica 1978; 46: 33–50.

    Article  Google Scholar 

  16. Rosner B, Cook N, Portman R, Daniels S, Falkner B . Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am J Epidemiol 2008; 167: 653–666.

    Article  CAS  Google Scholar 

  17. van Buuren S . Worm plot to diagnose fit in quantile regression. Stat Model 2007; 7: 363–376.

    Article  Google Scholar 

  18. Neuhauser HK, Thamm M, Ellert U, Hense HW, Rosario AS . Blood pressure percentiles by age and height from nonoverweight children and adolescents in Germany. Pediatrics 2011; 127: e978–e988.

    Article  Google Scholar 

  19. Barba G, Buck C, Bammann K, Hadjigeorgiou C, Hebestreit A, Mårild S et al. IDEFICS consortium. Blood pressure reference values for European non-overweight school children: the IDEFICS study. Int J Obes 2014; 38 (Suppl 2): S48–S56.

    Article  Google Scholar 

  20. Blake KV, Gurrin LC, Evans SF, Newnham JP, Landau LI, Stanley FJ et al. Reference ranges for blood pressure in preschool Australians, obtained by oscillometry. J Paediatr Child Health 2000; 36: 41–46.

    Article  CAS  Google Scholar 

  21. Hashimoto N, Kawasaki T, Kikuchi T, Uchiyama M . Criteria of normal blood pressure and hypertension in Japanese preschool children. J Hum Hypertens 1997; 11: 351–354.

    Article  CAS  Google Scholar 

  22. Ayatollahi SMT, Vakili MA, Behboodian J, Zare N . Reference values for blood pressure of healthy school children in Shiraz (Southern Iran) using quantile regression. Iran Cardiovasc Res J 2010; 4: 55–65.

    Google Scholar 

  23. Wei Y, Pere A, Koenker R, He X . Quantile regression methods for reference growth charts. Stat Med 2006; 25: 1369–1382.

    Article  Google Scholar 

  24. Monasta L, Lobstein T, Cole TJ, Vignerová J, Cattaneo A . Defining overweight and obesity in pre-school children: IOTF reference or WHO standard? Obes Rev 2011; 12 (4): 295–300.

    Article  CAS  Google Scholar 

  25. Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V et al. Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift Kinderheilkunde 2001; 149 (8): 807–818.

    Article  Google Scholar 

Download references

Acknowledgements

The following investigators, in addition to those listed as authors, participated in the field examinations of the OLA study: Bełchów: Danuta Moskwa, Andrzej Smalc; Biała Piska: Krystyna Skarzyńska; Biała Podlaska: Wiesława Jakubowska; Białystok: Justyna Tymińska-Zimnoch; Bielsk: Katarzyna Wiankowska; Brójce: Dariusz Kliszcz; Bydgoszcz: Ewa Rafalska; Celestynów: Dorota Malinowska; Charsznica: Maria Bogacz; Czernikowo: Halina Świątkowska; Damnica: Barbara Zawadzka; Dobre: Anna Nowicka; Drążdżewo: Dariusz Kossakowski; Gliwice: Jolanta Białek-Kaleta, Renata Karpiel; Gołańcz: Zenon Borucki; Gorzów Śląski: Renata Stefan; Górzno: Stanisław Masny; Gracze: Jacek Ciepluch; Jasło: Lucyna Mikrut, Janina Pięta; Jastrzębia: Renata Nowak; Jelenia Góra: Olga Knap, Elżbieta Laszczyk; Jędrzejów: Marta Łysek; Katowice: Aleksandra Mizera-Błaszczyk, Ewa Wiśniewska; Kołobrzeg: Ewa Kogutowicz-Reichel; Koronowo: Ryszard Tausz; Korzeniew: Błażej Ciamciak; Koszęcin: Adam Konina; Kraków: Julita Pabisek-Miernik, Urszula Stoncel, Małgorzata Wójcik; Książenice: Hanna Pawłowska; Lipiany: Paweł Zujko; Lipnica: Małgorzata Ogiejko-Szukała, Elżbieta Zielińska; Lubanie: Justyna Juralewicz; Lublin: Elżbieta Kotyrba, Urszula Pszczoła; Luboń: Hanna Olejniczak; Łagów: Ewa Wielgus-Aplas; Łódź: Urszula Górska, Marek Kasielski; Łubniany: Barbara Średzka-Burman; Mielec:Bogumiła Jachym, Tadeusz Zięba; Mieroszów: Lucyna Polańska, Piotr Polański; Mikstat:Kazimierz Kulikowski; Nakło nad Notecią: Monika Albrewczyńska; Niemodlin: Barbara Konior; Nowy Dwór Gdański: Lech Pietras; Nowy Sącz:, Lucyna Aschenbrenner, Irena Skowrońska, Alicja Wajrak-Fałowska; Olsztyn: Janusz Sielczak, Urszula Wiśniewska; Osiek: Zbigniew Jeczeń; Osielsko: Anna Żyta-Jazdon; Ostrożany: Maciej Wasilewski; Pakosław: Ewa Cempel-Nowak; Pleszew: Ewa Zdunek-Krawczyk; Poznań: Beata Wojciechowska-Martin; Przechlewo: Jacek Jastrzębski; Przesmyki: Anna Pożarowszczyk-Osik; Radzionków: Marzena Nordyńska-Sobczak; Reszel: Alicja Chałupa-Bońkowska, Krystyna Szczepańska; Rożnów: Aleksander Więcek; Ruda Śląska: Teresa Seweryn; Sępólno Krajeńskie: Teresa Ruthendorf-Przewoska; Sławno: Marzena Aurelia Paczkowska; Strzelce Opolskie: Marek Skrzypulec; Szczebrzeszyn: Urszula Chmura-Rozwadowska; Szczecin: Barbara Glura, Ewa Tomasik; Szczytno: Czesława Woźniak; Tarnów: Małgorzata Barnaś, Grażyna Rybczyk; Urzejowice: Władysław Liwak; Ustka: Elżbieta Barlik, Jolanta Roman, Grażyna Rostkowska, Krystyna Żelezik-Serafin; Warszawa: Anna Kwiatkowska, Małgorzata Mazurek, Weronika Michalec, Natalia Niedziela, Elżbieta Nowicka-Bursa, Małgorzata Nowosad, Grażyna Siemion, Alina Terlecka, Urszula Wyrzykowska, Małgorzata Zawiślak; Wieluń: Katarzyna Puławska; Wisznice: Ryszard Chustecki; Wodzisław Śląski: Jadwiga Rakszawska; Wolin: Wanda Aleksandra Jasiewicz; Wołomin: Maria Mikoszewska-Żołędziowska, Anna Uthke-Kluzek; Wrocław: Elżbieta Bombała, Monika Predko, Beata Stecka, Zuzanna Wolak-Listwan; Wysoka: Tomasz Domagalsk; Zabrze: Jolanta Chelus, Joanna Konieczna-Czmiel, Edyta Mordka, Karolina Ziółkowska; Zegartowice: Kazimierz Piotrowicz; Zgorzelec: Elżbieta Zarzycka-Żmiejko; Zielona Góra: Maria Zapotoczna; Złoczew: Anna Rakowska. The OLA study was supported by the National Centre for Research and Development (grant number N R13 0002 06). AG was supported by the Ministry of Science and Higher Education (grant for young scientist M7/13).

Author information

Authors and Affiliations

  1. Public Health Department, The Children’s Memorial Health Institute, Warsaw, Poland

    A Grajda, Z Kułaga, B Gurzkowska, M Wojtyło & M Góźdź

  2. Department of Nephrology and Arterial Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland

    M Litwin

Authors
  1. A Grajda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Z Kułaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Gurzkowska
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Wojtyło
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Góźdź
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M Litwin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Litwin.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grajda, A., Kułaga, Z., Gurzkowska, B. et al. Preschool children blood pressure percentiles by age and height. J Hum Hypertens 31, 400–408 (2017). https://doi.org/10.1038/jhh.2016.90

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.90

This article is cited by

Search

Advanced search

Quick links