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Chizuk HM, Willer BS, Horn EC, Haider MN, Leddy JJ. Sex differences in the Buffalo Concussion Treadmill Test in adolescents with acute sport-related concussion. J Sci Med Sport 2021; 24:876-880. [PMID: 33992537 DOI: 10.1016/j.jsams.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The Buffalo Concussion Treadmill Test (BCTT) is a safe and validated tool to assess exercise tolerance after sport-related concussion (SRC). Sex differences may affect the interpretation of this systematic exertion test in the concussed population, which is important for clinicians. The purpose of this study was to examine sex differences in BCTT performance in adolescents with acute SRC. DESIGN Prospective cohort. METHODS Male (n = 103, 15.3 ± 2 years) and female (n = 87, 15.1 ± 2 years) adolescents with SRC performed the BCTT within 10 days of injury. Heart rate (HR), HR threshold (HRt), Delta HR (difference between resting HR and HRt), symptom severity on Visual Analog Scale (VAS) and symptoms exacerbated on the BCTT were collected and compared. RESULTS Males had lower resting HR (M: 70.9 ± 12 vs F: 75.7 ± 13 bpm, p < 0.01) and reached a lower HRt than females (M: 134.7 ± 23 vs F: 141.5 ± 25 bpm, p = 0.05). Sexes did not differ on Delta HR (M: 63.8 ± 26 vs F: 65.9 ± 24 bpm, p = 0.57), total treadmill time (M: 9.3 ± 5 vs F: 8.4 ± 4 min, p = 0.20), maximum VAS (M: 5.0 ± 2 vs F: 5.4 ± 2, p = 0.18) or incidence of a change in VAS (M: 91% vs F: 94%, p = 0.43) on the BCTT. CONCLUSIONS Although males may reach symptom exacerbation at a slightly lower mean HRt than females on the BCTT within 10 days of SRC, the BCTT provides comparable information and both sexes reach symptom exacerbation at similar Delta HR.
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Affiliation(s)
- Haley M Chizuk
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, United States of America; UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, United States of America.
| | - Barry S Willer
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, United States of America; Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, United States of America
| | - Emily C Horn
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, United States of America
| | - Mohammad N Haider
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, United States of America
| | - John J Leddy
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, United States of America; UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, United States of America
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2
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Hardy ST, Urbina EM. Blood Pressure in Childhood and Adolescence. Am J Hypertens 2021; 34:242-249. [PMID: 33821942 PMCID: PMC8022980 DOI: 10.1093/ajh/hpab004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/05/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Elevated blood pressure (BP) and hypertension commonly occur in children and adolescents and increase the risk of cardiovascular disease in adulthood. The purpose of this review is to summarize recent research in pediatric hypertension including changes in defining hypertension, BP measurement techniques, hypertension epidemiology, risk factors, treatment, and BP-related target organ damage. Defining pediatric hypertension using the 2017 American Academy of Pediatrics' updated Clinical Practice Guideline resulted in a larger proportion of children being classified as having elevated BP or hypertension compared with prior guidelines. Trends in the distribution of BP among US children and adolescents suggest that BP levels and the prevalence of hypertension may have increased from 2011-2014 to 2015-2018. Factors including a family history of hypertension, obesity, minority race/ethnicity, physical inactivity, high dietary intake of sodium, and poor sleep quality are associated with an increased prevalence of elevated BP and hypertension. Evidence of a linear relationship between systolic BP and target organ damage indicates that BP levels currently considered normal could increase the risk of target organ damage in childhood. Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, are a central component of effectively reducing BP and have been shown to reduce target organ damage. Pharmacologic treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is an effective and safe method for reducing BP among children with uncontrolled BP after implementing lifestyle changes. Research gaps in the prevention, detection, classification, and treatment of hypertension in children demonstrate opportunities for future study.
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Affiliation(s)
- Shakia T Hardy
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children’s Hospital, and the University of Cincinnati, Cincinnati, Ohio, USA
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3
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Hsu CY, Lin RH, Lin YC, Chen JY, Li WC, Lee LA, Liu KH, Chuang HH. Are Body Composition Parameters Better than Conventional Anthropometric Measures in Predicting Pediatric Hypertension? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5771. [PMID: 32785000 PMCID: PMC7460262 DOI: 10.3390/ijerph17165771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/03/2022]
Abstract
Body composition (BC) parameters are associated with cardiometabolic diseases in children; however, the importance of BC parameters for predicting pediatric hypertension is inconclusive. This cross-sectional study aimed to compare the difference in predictive values of BC parameters and conventional anthropometric measures for pediatric hypertension in school-aged children. A total of 340 children (177 girls and 163 boys) with a mean age of 8.8 ± 1.7 years and mean body mass index (BMI) z-score of 0.50 ± 1.24 were enrolled (102 hypertensive children and 238 normotensive children). Significantly higher values of anthropometric measures (BMI, BMI z-score, BMI percentile, waist-to-height ratio) and BC parameters (body-fat percentage, muscle weight, fat mass, fat-free mass) were observed among the hypertensive subgroup compared to their normotensive counterparts. A prediction model combining fat mass ≥ 3.65 kg and fat-free mass ≥ 34.65 kg (area under the receiver operating characteristic curve = 0.688; sensitivity = 66.7%; specificity = 89.9%) performed better than BMI alone (area under the receiver operating characteristic curve = 0.649; sensitivity = 55.9%; specificity = 73.9%) in predicting hypertension. In conclusion, BC parameters are better than anthropometric measures in predicting pediatric hypertension. BC measuring is a reasonable approach for risk stratification in pediatric hypertension.
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Affiliation(s)
- Chih-Yu Hsu
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
| | - Rong-Ho Lin
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan;
| | - Yu-Ching Lin
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
- Department of Imaging and Intervention, Chang Gang Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
- Department of Otorhinolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan;
| | - Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
- Obesity Institute & Genomic Medicine Institute, Geisinger, Danville, PA 17837, USA
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4
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Yazdi M, Assadi F, Daniali SS, Heshmat R, Mehrkash M, Motlagh ME, Qorbani M, Kelishadi R. Performance of modified blood pressure-to-height ratio for diagnosis of hypertension in children: The CASPIAN-V study. J Clin Hypertens (Greenwich) 2020; 22:867-875. [PMID: 32297452 DOI: 10.1111/jch.13860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/30/2020] [Accepted: 02/20/2020] [Indexed: 12/28/2022]
Abstract
This study aimed to evaluate the accuracy and performance of modified blood pressure-to-height ratio (MBPHR) for identifying high blood pressure (HBP) in a large population of children. This multicentric cross-sectional study was conducted on a nationally representative sample of 7349 Iranian students aged 7-12 years living in 30 provinces in Iran. High systolic blood pressure and diastolic blood pressure were defined according to the 2017 American Academy of Pediatrics (AAP) guidelines. The BP-to height ratio (BPHR) was calculated as BP (mmHg)/height (cm), MBPHR3 as BP (mmHg)/(height (cm) + 3 (13-age)), and MBPHR7 as BP (mmHg)/(height (cm) + 7 (13-age). The receiver-operating characteristic curve analysis was used to evaluate the performance of these three ratios for identification of HBP in children compared to the 2017 AAP guidelines as the gold standard. Mean age of participants was 12.29 ± 3.15 years and 3736 (50.8%) were girls. The prevalence of HBP was 11.9% (11.5% in boys, 12.3% in girls). The area under the curve (AUC) was higher for MSBPHR3/MDBPHR3 (0.97/0.98) than MSBPHR7/MDBPHR7 (0.96/0.97) and SBPHR/DBPHR (0.96/0.95) for identifying high Systolic and diastolic BP. The optimal cut-off points for MSBPHR3/MDBPH, MSBPHR7/MDBPHR7, and SBPHR/DBPHR were 0.76/0.50, 0.69/0.46, and 0.81/0.52 respectively. Negative predictive value was nearly perfect for three ratios (≥98%). Positive predictive value was higher for MBPHR3 (52.7%) than MBPHR7 (51.0%) and BPHR (39.8%). Overall, MBPHR3 had better performance than MBPHR7 and BPHR for identification of HBP in Iranian children and it may improve early hypertension recognition and control in primary screening.
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Affiliation(s)
- Maryam Yazdi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farahnak Assadi
- Department of Pediatrics, Rush University Medical College, Chicago, IL, USA
| | - Seyed S Daniali
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehryar Mehrkash
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad E Motlagh
- Pediatrics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mostafa Qorbani
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Stabouli S, Antza C, Chrysaidou K, Kotsis V. The challenge of simplifying blood pressure screening in children and adolescents. J Clin Hypertens (Greenwich) 2020; 22:876-878. [PMID: 32282118 DOI: 10.1111/jch.13858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Simplified methods of blood pressure screening could facilitate the clinical routine of the primary care physicians and may increase adherence to pediatric hypertension guidelines. Blood-pressure-to-height ratios are appealing for the simplicity of data needed to evaluate a child's blood pressure status, including only office blood pressure values and height. In several epidemiological studies around the world blood-pressure-to-height ratios showed good predictive power in identifying children with high blood pressure in terms of area under the curve and sensitivity compared to the gold standard National High Blood Pressure Education Program blood pressure tables, but low positive predictive values meaning a high rate of false-positive cases and possibly increased subsequent work load for primary physicians. Finally, blood-pressure-to height ratios seem to be dependent to age, sex, and weight status. In conclusion, blood-pressure-to-height ratios need to be further improved and validated in different pediatric populations before routine clinical use.
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Affiliation(s)
- Stella Stabouli
- 1st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Christina Antza
- Hypertension-24h ABPM ESH Center of Excellence, 3rd Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Katerina Chrysaidou
- 1st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Vasilios Kotsis
- Hypertension-24h ABPM ESH Center of Excellence, 3rd Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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6
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Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda. J Hum Hypertens 2019; 34:76-81. [PMID: 31792440 DOI: 10.1038/s41371-019-0292-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/10/2019] [Accepted: 11/20/2019] [Indexed: 01/26/2023]
Abstract
Hypertension is the number one risk factor for cardiovascular diseases worldwide and yet its diagnosis among adolescents, based on blood pressure percentiles which are age, height, and sex-specific, is complex. Our study intended to determine the suitability of blood pressure height index in defining adolescent hypertension among secondary school adolescents aged 12-17 years in Mbarara municipality, southwestern Uganda. Our study used data of 485 secondary school adolescents of which 173 were boys. Receiver operating characteristic curve analysis was performed to assess the performance of systolic blood pressure height index (SBPHI) and diastolic blood pressure height index (DBPHI) for screening for adolescent prehypertension and hypertension. The optimal systolic/diastolic thresholds for defining prehypertension were 0.70/0.43 mmHg/cm in boys and 0.76/0.43 in girls. The corresponding values for hypertension were 0.78/0.43 and 0.77/0.48 mmHg/cm, respectively. The negative predictive values were much higher (all ≥ 95%) for prehypertension and hypertension, while the positive predictive value was 100% for hypertension in both sexes. In conclusion, Blood pressure height index is simple and accurate for screening for prehypertension and hypertension in adolescents aged 12-17 years hence can be used for early screening of adolescents at high risk of hypertension but not its diagnosis.
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7
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Ma C, Lu Q, Wang R, Yin F. Using height-corrected definition of metabolic syndrome in children and adolescents. J Pediatr Endocrinol Metab 2019; 32:429-438. [PMID: 31050656 DOI: 10.1515/jpem-2018-0414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/23/2019] [Indexed: 02/06/2023]
Abstract
Metabolic syndrome (MS) is common among children and adolescents. Age- and gender-specific references or age-, gender- and height-specific references were used in pediatric MS definitions. More recently, an increasing number of studies documented that the ratio of waist circumference (WC) to height (WHtR) and blood pressure to height (BPHR) were easy anthropometric indexes for detection of obesity and hypertension in children and adolescents. For these reasons, height-corrected MS definition was proposed. WHtR and BPHR were used as alternatives to WC and BP in the definition of MS. In the present review, we discuss the possibility of the height-corrected MS definition for identifying MS in children.
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Affiliation(s)
- Chunming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fuzai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao 066000, Hebei Province, China, Phone: +86-335-3634208, Fax: +86-335-3032042
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8
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Zhang Y, Yang L, Hou Y, Zhao M, Chiolero A, Bovet P, Xi B. A simple table based on height to assess elevated and high blood pressure in children. J Hum Hypertens 2018; 33:248-254. [PMID: 30401980 DOI: 10.1038/s41371-018-0128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/29/2018] [Accepted: 10/22/2018] [Indexed: 11/09/2022]
Abstract
The 2017 American Academy of Pediatrics (AAP) guideline for assessing "elevated blood pressure (BP) (90th BP percentile)" and "high BP (95th BP percentile)" includes a large number of BP cut-offs based on sex, age and height, which makes it cumbersome to use in clinical practice. We developed and evaluated the performance of a simple table based on a child's height only to assess elevated and high BP in children compared to the reference AAP guideline based on sex, age and height. Data came from 6816 children aged 8-12 years from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2016 and 3145 participants aged 5-12 years from NHANES III (1988-1994). Compared to the reference AAP guideline, the simple table had high values of AUC (0.96/0.91), sensitivity (92.7%/83.2%), specificity (99.0%/99.4%), PPV (92.6%/89.3%), NPV (99.0%/99.0%), and Kappa coefficient (0.92/0.85) for screening elevated/high BP when applied to NHANES, and values were similarly high when applied to NHANES III. These findings show that the simple table based on height only performed nearly as well as the reference 2017 AAP guideline based on sex, age and height for assessing elevated and high BP in U.S. children. This simple table may be a useful screening tool to assess high BP in children aged 5-12 years, particularly in a context of mass screening programs.
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Affiliation(s)
- Yuanyuan Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Yaping Hou
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Arnaud Chiolero
- Institute of Primary Health Care, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Department of Epidemiology, McGill University, Montreal, Canada
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
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Ma C, Wang R, Liu Y, Lu Q, Lu N, Tian Y, Liu X, Yin F. Performance of User-Friendly Screening Tools for Elevated Blood Pressure in Children. Pediatrics 2017; 139:peds.2016-1986. [PMID: 28057844 DOI: 10.1542/peds.2016-1986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Hypertension is frequently undiagnosed in children. Several methods have been developed to simplify screening for elevated blood pressure (BP) in children. OBJECTIVE to assess the performance of different screening tools in identifying elevated BP in the pediatric population. DATA SOURCES Data sources such as PubMed, Embase, Web of Science, Cochrane, and Scopus were searched up to March 2016. STUDY SELECTION Studies providing measures of diagnostic performance of screening tools and that used age-, sex-, and height-specific BP percentile as the reference standard were included. DATA EXTRACTION Data regarding the population, screening tools used to define elevated BP, and diagnostic criteria of BP were extracted. Available data on true-positive, false-positive, true-negative, and false-negative results were also extracted to construct a 2 × 2 contingency table. RESULTS A total of 16 eligible studies that evaluated 366 321 children aged 3 to 18 years were included in the meta-analysis. Nine screening tools were included in this study, in which the BP-to-height ratio, the modified BP-to-height ratio, and tables based on age categories had the highest sensitivities (97-98%) but moderate specificities (71-89%). LIMITATIONS Limitations included that BP measurements in most studies were based on 1 visit only and there was heterogeneity between the studies. CONCLUSIONS Several user-friendly screening tools could improve the screening of elevated BP in the pediatric population.
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Affiliation(s)
- Chunming Ma
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yue Liu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qiang Lu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Na Lu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yiming Tian
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiaoli Liu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fuzai Yin
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China
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10
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Wang LY, Liu Q, Cheng XT, Jiang JJ, Wang H. Blood pressure-to-height ratio as a screening indicator of elevated blood pressure among children and adolescents in Chongqing, China. J Hum Hypertens 2016; 31:438-443. [PMID: 28032627 DOI: 10.1038/jhh.2016.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022]
Abstract
We aimed to evaluate the performance of blood pressure-to-height ratio (BPHR) and establish their optimal thresholds for elevated blood pressure (BP) among children aged 6 to 17 years in Chongqing, China. Data were collected from 11 029 children and adolescents aged 6-17 years in 12 schools in Chongqing according to multistage stratified cluster sampling method. The gold standard for elevated BP was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ⩾95th percentile for gender, age and height. The diagnostic performance of systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) to screen for elevated BP was evaluated through receiver-operating characteristic curves (including the area under the curve (AUC) and its 95% confidence interval, sensitivity and specificity). The prevalence of elevated BP in children and adolescents in Chongqing was 10.36% by SBP and/or DBP ⩾95th percentile for gender, age and height. The optimal thresholds of SBPHR/DBPHR for identifying elevated BP were 0.86/0.58 for boys and 0.85/0.57 for girls among children aged 6 to 8 years, 0.81/0.53 for boys and 0.80/0.52 for girls among children aged 9 to 11 years and 0.71/0.45 for boys and 0.72/0.47 for girls among adolescents aged 12-17 years, respectively. Across gender and the specified age groups, AUC ranged from 0.82 to 0.88, sensitivity were above 0.94 and the specificities were over 0.7. The positive predictive values ranged from 0.30 to 0.38 and the negative predictive values were ⩾0.99. BPHR, with uniform values across broad age groups (6-8, 9-11 and 12-17 years) for boys and for girls is a simple indicator to screen elevated BP in children and adolescents in Chongqing.
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Affiliation(s)
- L Y Wang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Q Liu
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - X T Cheng
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - J J Jiang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - H Wang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
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