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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.
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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
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