1
|
Pérez-Gimeno G, Ruperez AI, Gil-Campos M, Aguilera CM, Anguita A, Vázquez-Cobela R, Skapino E, Moreno LA, Leis R, Bueno-Lozano G. Height-based equations as screening tools for high blood pressure in pediatric practice, the GENOBOX study. J Clin Hypertens (Greenwich) 2022; 24:713-722. [PMID: 35596598 PMCID: PMC9180328 DOI: 10.1111/jch.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
Due to the absence of easily applicable cut‐off points to determine high blood pressure or hypertension in children, as in the adult population, blood pressure is rarely measured in the pediatrician's clinical routine. This has led to an underdiagnosis of high blood pressure or hypertension in children. For this reason, the present study evaluate the utility of five equations for the screening of high blood pressure in children: blood pressure to height ratio, modified blood pressure to height ratio, new modified blood pressure to height ratio, new simple formula and height‐based equations. The authors evaluated 1599 children between 5 and 18 years. The performance of the five equations was analyzed using the receiver‐operating characteristics curves for identifying blood pressure above P90th according to the American Academy of Pediatrics Clinical Practice Guideline 2017. All equations showed an area under the curve above 0.882. The new modified blood pressure to height ratio revealed a high sensitivity whereas the height‐based equations showed the best performance, with a positive predictive value above 88.2%. Finally, all equations showed higher positive predictive values in children with overweight or obesity. The height‐based equation obtained the highest PPV values above 71.1% in children with normal weight and above 90.2% in children with overweight or obesity. In conclusions, the authors recommend the use of the height‐based equations equation because it showed the best positive predictive values to identify children with elevated blood pressure, independently of their sex, pubertal and weight status.
Collapse
Affiliation(s)
- Gloria Pérez-Gimeno
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain
| | - Azahara I Ruperez
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain
| | - Mercedes Gil-Campos
- Metabolic Pediatric and Investigation Unit, Reina Sofía University Hospital, Maimónides Insitute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain.,CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Concepción M Aguilera
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", Center of Biomedical Research, University of Granada, Armilla, Granada, Spain.,Biosanitary Research Institute (IBS), University of Granada, Granada, Spain
| | - Augusto Anguita
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", Center of Biomedical Research, University of Granada, Armilla, Granada, Spain.,Biosanitary Research Institute (IBS), University of Granada, Granada, Spain
| | - Rocío Vázquez-Cobela
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Pediatric Nutrition Research Group. Institute of Sanitary Research of Santiago de Compostela (IDIS). CHUS-USC., Santiago de Compostela, Spain.,Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Unit of Pediatric Gastroenterology, Hepatology and Nutrition. Pediatric Service. University Clinical Hospital of Santiago (CHUS)., Santiago de Compostela, Spain
| | - Estela Skapino
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.,Department of Clinical Nutrition, School of Nutrition, University of the Republic, Montevideo, Uruguay
| | - Luis A Moreno
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.,CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Rosaura Leis
- CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Pediatric Nutrition Research Group. Institute of Sanitary Research of Santiago de Compostela (IDIS). CHUS-USC., Santiago de Compostela, Spain.,Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Unit of Pediatric Gastroenterology, Hepatology and Nutrition. Pediatric Service. University Clinical Hospital of Santiago (CHUS)., Santiago de Compostela, Spain
| | - Gloria Bueno-Lozano
- Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.,CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain.,Unit of Pediatric Endocrinology, University Clinical Hospital Lozano Blesa, Zaragoza, Spain
| |
Collapse
|
2
|
Skapino E, Rupérez AI, Restrepo-Mesa S, Araújo-Moura K, De Moraes AC, Barbosa Carvalho H, Aristizabal JC, Moreno LA. Height-based equations as screening tools for elevated blood pressure in the SAYCARE study. J Clin Hypertens (Greenwich) 2020; 22:2221-2229. [PMID: 33125808 DOI: 10.1111/jch.14087] [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: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
This study evaluated the accuracy of four height-based equations: blood pressure to height ratio (BPHR), modified BPHR (MBPHR), new modified BPHR (NMBPHR), and height-based equations (HBE) for screening elevated BP in children and adolescents in the SAYCARE study. We measured height and BP of 829 children and adolescents from seven South American cities. Receiving operating curves were used to assess formula performance to diagnose elevated BP in comparison to the 2017 clinical guideline. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the four screening formulas. The diagnostic agreement was evaluated with the kappa coefficient. The HBE equation showed the maximum sensitivity (100%) in children, both for boys and girls, and showed the best performance results, with a very high NPV (>99%) and high PPV (>60%) except for female children (53.8%). In adolescents, the highest sensitivity (100%) was achieved with the NMBPHR for both sexes. Kappa coefficients indicated that HBE had the highest agreement with the gold standard diagnostic method (between 0.70 and 0.75), except for female children (0.57). Simplified methods are friendlier than the percentile gold standard tables. The HBE equation showed better performance than the other formulas in this Latin American pediatric population.
Collapse
Affiliation(s)
- Estela Skapino
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay.,Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza
| | - Azahara Iris Rupérez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza.,Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Sandra Restrepo-Mesa
- Food and Human Nutrition Research Group, School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia
| | - Keisyanne Araújo-Moura
- Graduate Program in Public Health, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.,Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.,YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Augusto César De Moraes
- Graduate Program in Public Health, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.,Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.,YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Heráclito Barbosa Carvalho
- YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juan Carlos Aristizabal
- Grupo de Investigación en Fisiología y Bioquímica (PHYSIS), Escuela de Nutrición y Dietética, Universidad de Antioquia, Medellín, Colombia
| | - Luis Alberto Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza.,Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Chmiel Z, Żal M, Więch P, Bazaliński D, Sałacińska I, Bartusik-Aebisher D, Binkowska-Bury M. Hypertension and selected indicators of health assessment in a population of 19-year-old men subject to military qualifications. Medicine (Baltimore) 2020; 99:e20398. [PMID: 32481430 DOI: 10.1097/md.0000000000020398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Małopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.
Collapse
Affiliation(s)
- Zdzisława Chmiel
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Marcin Żal
- Head of the Provincial Military Staff in Krakow, Rydla 19, 30-901 Krakow
| | - Paweł Więch
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Dariusz Bazaliński
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Izabela Sałacińska
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Dorota Bartusik-Aebisher
- Institute of Medical Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow, Poland
| | - Monika Binkowska-Bury
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Di Bonito P, Licenziati MR, Di Sessa A, Manco M, Morandi A, Maffeis C, Chiesa C, Pacifico L, Valerio G. A new simple formula built on the American Academy of Pediatrics criteria for the screening of hypertension in overweight/obese children. Eur J Pediatr 2019; 178:1291-1295. [PMID: 31214774 DOI: 10.1007/s00431-019-03410-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 11/30/2022]
Abstract
We evaluated the performance of a new simple formula (NSF) for the screening of hypertension by American Academy of Pediatrics Guidelines 2017 (AAPG2017) in children with overweight/obesity (OW/OB). The performance of the NSF and the modified blood pressure to height ratio (MBPHR3) thresholds against AAPG2017 was evaluated; both methods were also compared to assess the association with concentric left ventricular hypertrophy (cLVH). The study included 3259 OW/OB children (5-13 years). Two centers served as learning sample (LS) (n = 1428), four centers served as validation sample (VS) (n = 1831), and the echocardiographic evaluation was available in 409 children in VS. The NSF was [1.5 × systolic blood pressure (mmHg) + diastolic blood pressure (mmHg)] - [(26 × height (m)] - age (years). A cut-off of the NSF ≥ 193 mmHg showed sensitivity, specificity, positive, and negative predictive values of 0.92, 0.93, 0.83, and 0.97, respectively, versus the standard procedure. Against AAPG2017, the NSF showed higher specificity and positive predictive values than the MBPHR3 thresholds. Among hypertensive children defined by AAPG2017, NSF, or MBPHR3, the odds ratio (95%CI) for cLVH was respectively 1.73 (1.06-2.83), 1.69 (1.05-2.75), and 1.18 (0.75-1.85).Conclusions: The NSF shows a very high performance for the screening of OW/OB children at risk of hypertension and cLVH. What is Known: • The American Academy of Pediatrics released updated guidelines (AAPG 2017) to classify hypertension (HTN) in children. • The process needs categorization of height percentiles and comparison of blood pressure versus gender and age-adjusted values. What is New: • A user-friendly formula built on the AAPG 2017 was validated for the categorization of HTN in children with overweight/obesity. • The formula showed high performance in identifying children with HTN versus the standard procedure (sensitivity 0.92, specificity 0.93) and similar ability in identifying hypertensive children with concentric left ventricular hypertrophy versus the standard procedure (40% and 39% respectively).
Collapse
Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - Maria Rosaria Licenziati
- Obesity and Endocrine disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Melania Manco
- IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
| |
Collapse
|