Improving Hypertension Screening in Childhood Using Modified Blood Pressure to Height Ratio

Optimal Lung Cancer Screening Criteria Among Persons Living With HIV

BACKGROUND

The US Preventive Services Task Force (USPSTF) 2021 updated recommendations on lung cancer screening with chest computed tomography to apply to individuals 50-80 years of age (previously 55-80 years), with a ≥20 pack-year history (previously ≥30), whether currently smoking or quit ≤15 years ago. Despite being at higher risk for lung cancer, persons with HIV (PWH) were not well-represented in the National Lung Screening Trial, which informed the USPSTF 2013 recommendations. It is unknown or unclear how PWH are affected by the 2021 recommendations.

SETTING

This study was a retrospective analysis of PWH with and without lung cancer in the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study.

METHODS

We identified PWH, ages 40-80 years, who currently or previously smoked, with (cases) and without lung cancer (noncases). The sensitivity and specificity of the old, new, and alternative screening criteria were evaluated in each cohort.

RESULTS

We identified 52 women and 19 men with lung cancer and 1950 women and 1599 men without lung cancer. Only 11 women (22%) and 6 men (32%) with lung cancer met 2013 screening criteria; however, more women (22; 44%) and men (12; 63%) met 2021 criteria. Decreased age and tobacco exposure thresholds in women further increased sensitivity of the 2021 criteria.

CONCLUSIONS

The 2021 USPSTF lung cancer screening recommendations would have resulted in more PWH with lung cancer being eligible for screening at the time of their diagnosis. Further investigation is needed to determine optimal screening criteria for PWH, particularly in women.

Performance of modified blood pressure-to-height ratio for diagnosis of hypertension in children: The CASPIAN-V study

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.

The challenge of simplifying blood pressure screening in children and adolescents

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.

Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda

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.

Performance of User-Friendly Screening Tools for Elevated Blood Pressure in Children

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.

Improving Hypertension Screening in Childhood Using Modified Blood Pressure to Height Ratio

Blood pressure to height ratio (BPHR) has been suggested as a simple method for screening children with hypertension, but its discriminatory ability in young children is not as good as that in older children. Using data of 89,664 Chinese children aged 7 to 11 years, the authors assessed whether modified BPHR (BP:eHT13) was better than BPHR in identifying young children with hypertension. BP:eHT13 was estimated as BP/(height+7×(13-age in years)). Using Youden's index, the thresholds of systolic/diastolic BP:eHT13 for identifying prehypertension and hypertension were 0.67/0.44 and 0.69/0.45, respectively. These proposed thresholds revealed high sensitivity, specificity, negative predictive value, and area under the curve (AUC), ranging from 0.874 to 0.999. In addition, BP:eHT13 showed better AUCs and fewer cutoff points than, if not similar to, two existing BPHR references. BP:eHT13 generally performed better than BPHR in discriminating BP abnormalities in young children and may improve early hypertension recognition and control.

Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis

The aim of this study was to assess the performance of the blood pressure-to-height ratio (BPHR) for screening elevated blood pressure (BP) in children and adolescents using a meta-analysis of eligible published studies. We retrieved studies that investigated the performance of the BPHR for identifying elevated BP from Pubmed and other databases. We performed meta-analyses by subgroups of sex, age and ethnicity using a fixed or random effect model based on whether there was between-study heterogeneity. A total of 13 publications including 262 830 children and adolescents aged 6-18 years on BPHR and a total of three publications including 95 343 children on the modified BPHR were included in this meta-analysis. The summary results suggested that BPHR performed well to identify pre-high BP and high BP for children aged 6-11 years and adolescents aged 12-18 years. The performance of BPHR was perfect for identifying severe high BP in adolescents aged 12-18 years. However, the modified BPHR did not improve accuracy for screening high BP in children aged 6-12 years. In summary, BPHR performed well for identifying elevated BP in children and adolescents, independently of sex, age and ethnicity group. In addition, the modified BPHR performed similarly with BPHR for screening high BP in childhood.