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Mynard JP, Chaturvedi S, Cheung MMH, Clark M, Gabb G, Jeffries-Stokes C, Jennings GL, McNab S, Medley T, Mihailidou AS, Schlaich M, Larkins NG, Quinlan C. A Call for Australian Clinical Practice Guidelines for Paediatric Hypertension. Heart Lung Circ 2023; 32:1032-1034. [PMID: 37495429 DOI: 10.1016/j.hlc.2023.06.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Vic, Australia.
| | - Swasti Chaturvedi
- Department of Nephrology, Sydney Children's Hospital, Sydney, NSW, Australia; Menzies School of Health Research Darwin, NT, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Malcolm Clark
- Department of General Practice, University of Melbourne, Melbourne, Vic, Australia
| | - Genevieve Gabb
- Department of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Garry L Jennings
- National Heart Foundation of Australia, Melbourne, Vic, Australia
| | - Sarah McNab
- Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Vic, Australia; Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Tanya Medley
- Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH, Perth, WA, Australia; Research Foundation, The University of Western Australia, Perth, WA, Australia; Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Department of Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Nicholas G Larkins
- Department of Nephrology, Perth Children's Hospital, Perth, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Catherine Quinlan
- Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of Nephrology, Royal Children's Hospital, Melbourne, Vic, Australia; Digital Health, Melbourne Children's Centre for Health Analytics, Melbourne, Vic, Australia; Kidney Flagship, Murdoch Children's Research Institute, Melbourne, Vic, Australia
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Performance of simplified tables for high blood pressure screening in a European pediatric population. J Hypertens 2018; 37:917-922. [PMID: 30308597 DOI: 10.1097/hjh.0000000000001972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed the performance of the simplified American Academy Pediatrics (AAP) 2017 guideline table and a simplified table based on the Fourth Report blood pressure (BP) reference tables for high BP screening compared with the European Society Hypertension 2016 guideline diagnostic thresholds. METHODS We obtained data from a cross-sectional, school-based screening study in north Greece during 2013-2016. BP was measured by mercury sphygmomanometer. The simple tables' performance for high BP was assessed by receiver operator characteristic curve analysis, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The study population included 1846 children aged 6-12 years and 986 adolescents aged 13-18 years. Compared with the European Society Hypertension 2016 classification, the AAP 2017 simple table showed AUC 0.93, sensitivity 95.5%, specificity 91.6%, PPV 35.9%, and NPV 99.7%, whereas the Fourth Report one showed AUC 0.96, sensitivity 99.2%, specificity 93.2%, PPV 42.1%, and NPV 99.9%. Comparing the prevalence of high BP by the two tables, we found agreement in 96.9% of the participants, and disagreement in 3.1% (kappa coefficient = 0.85, P < 0.001). 20.8% of the adolescents classified for further screening by the Fourth Report, but not by the AAP 2017 simple table, had BP levels at the high-normal category. CONCLUSION Simple tables for BP screening based on age present good performance to identify children and adolescents with high BP levels. However, they may provide high rate of false positive results, and the simple table by the AAP 2017 guideline may fail to classify some adolescents eligible for further BP evaluation.
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Narang R, Saxena A, Desai A, Ramakrishnan S, Thangjam RS, Kulkarni S, Narvencar K, E Costa AKJ, Dias A, Sukharamwala R, Cleland J. Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study. Eur J Prev Cardiol 2018; 25:1775-1784. [PMID: 30043628 DOI: 10.1177/2047487318790056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Hypertension in children is often under recognized, especially in developing countries. Data from rural areas of developing countries is particularly lacking. Objectives To study prevalence of hypertension and its determinants in apparently health school children from predominantly rural populations of India. Methods Apparently healthy schoolchildren ( n = 14,957) aged 5-15 years (mean (standard deviation) age 10.8 (2.8) years; 55.5% boys) at four predominantly rural sites in separate states of India were studied. Systolic and diastolic blood pressures were recorded by trained staff in addition to age, gender, height, weight, type of school and season. Waist circumference was also recorded in 12,068 children. Geographic location and type of school (government, government-aided or private) were used to determine socio-economic status. Results Systolic and/or diastolic hypertension was present in 3443 (23%) children. Systolic hypertension was present in 13.6%, diastolic hypertension in 15.3% and both in 5.9%. Isolated systolic hypertension was present in 7.7% while isolated diastolic hypertension was present in 9.4%. On univariate analysis, age, gender, geographical location, socio-economic status, season and anthropometric parameters (z-scores of height, weight and waist circumference, waist/height ratio and body mass index) were all significantly related to risk of hypertension ( p < 0.0001 for each). Similar association was observed with weight group (normal, overweight and obese). Multiple regression analysis showed lower age, female gender, richer socio-economic status, certain geographical locations, higher weight and larger waist circumference to be independently associated with a greater risk of hypertension. Conclusion There is a high prevalence of hypertension in apparently healthy schoolchildren even in predominantly rural areas of India. Screening and management programs targeted to high risk groups identified may prove cost-effective.
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Affiliation(s)
- Rajiv Narang
- 1 Department of Cardiology, All India Institute of Medical Sciences, India
| | - Anita Saxena
- 1 Department of Cardiology, All India Institute of Medical Sciences, India
| | - Ankush Desai
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | | | - Rajendra S Thangjam
- 3 Department of Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | | | - Kedareshwar Narvencar
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | - Ana K Jacques' E Costa
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | - Amit Dias
- 2 Department of Medicine and Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
| | | | - John Cleland
- 5 Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, UK
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