Comparison of Different Screening Methods for Hypertension in Han Adolescents

Validation of recommended definition in identifying elevated blood pressure in adolescents

Recently, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds for identifying elevated blood pressure (BP) in adolescents aged 13-17 years. The authors aimed to compare the performance of the new definition in identifying elevated BP with traditional percentile-based definition. Data were obtained from the National Health and Nutrition Examination Survey 1999-2014, which included 7485 adolescents aged 13-17 years. Elevated BP was defined using the recommended (≥120/80 mm Hg) and traditional definition (≥90th percentile for sex, age, and height or 120/80 mm Hg) presented in AAP guideline. The prevalence of elevated BP was 15.7% and 17.2% using the recommended and traditional definition, respectively (P < .001). The recommended definition had high sensitivity (90.9%), perfect specificity (100.0%), perfect positive predictive value (100.0%), and very high negative predictive value (98.1%) compared with the traditional definition. The Kappa correlation coefficient between two definitions was 0.94 (P < .001). Similar results can be observed in subgroups across sex, age, and sex- and age-specific height percentile except for both sexes with young age and low height percentile. Generally, our results supported the use of the recommended definition for identifying elevated BP in adolescents.

Anthropometric predictors of systolic and diastolic blood pressure considering intersexual differences in a group of selected schoolchildren

OBJECTIVES

Although the association between anthropometric parameters and blood pressure has been established for adults, the relationship for children has not been thoroughly studied in Slovakia. Present study investigates the association between anthropometric parameters and systolic and diastolic blood pressure in the group of randomly selected schoolchildren.

METHODS

Examinations were conducted as a cross-sectional study with 760 schoolchildren from Eastern Slovakia, 381 boys and 379 girls. The blood pressure evaluation included sphygmomanometer technique (seated, 3 times repeated) measurement of systolic and diastolic blood pressure (SBP; DBP). Anthropometric measurements included: body weight, height, circumference of waist, hip and chest, BMI, WHR (waist-hip ratio), fat skinfolds measurement, triceps skinfold, and derivation of body fat percentage. The parents' questionnaires incorporated basic demographic and socioeconomic characteristics of the family, reported BMI of father and mother, and child's birth-weight and birth-length. Statistical analysis included Student's t-test gender differences in measured parameters, partial Pearson's correlations and linear regression model of the impact of body parameters Z-scores on SBP and DPB.

RESULTS

Statistical analysis confirmed gender difference in basic anthropometric parameters. Pearson's correlations revealed highly significant relationship of anthropometric indices to SBP compared to DBP. Correlations of anthropometric parameters with SBP and DPB were more significant for boys compared to girls. Linear regression analysis showed that the highest impact on SBP and DBP had Z-score of BMI, followed by weight and height. Z-score of body weight has statistical impact on SBP and DBP in all group and group of boys (p < 0.001), lower significance was in DBP of girls (p < 0.01). Similar results were obtained for Z-score of height and BMI for SBP and DBP in both total group and group of boys on level p < 0.001. Z-score for BMI and height in DBP has lower statistical significance.

CONCLUSIONS

Linear regression model confirmed higher statistical relationship of SBP and DBP in the group of boys compared to the group of girls. SBP correlations and linear regression model of anthropometric parameters revealed more significant outputs compared to DPB. The results confirmed the fact that we have to consider anthropometric indices in paediatric blood pressure evaluation.

Can Pediatric Hypertension Criteria Be Simplified? A Prediction Analysis of Subclinical Cardiovascular Outcomes From the Bogalusa Heart Study

Prehypertension and hypertension in childhood are defined by sex-, age-, and height-specific 90th (or ≥120/80 mm Hg) and 95th percentiles of blood pressure, respectively, by the 2004 Fourth Report. However, these cutoffs are complex and cumbersome for use. This study assessed the performance of a simplified blood pressure definition to predict adult hypertension and subclinical cardiovascular disease. The cohort consisted of 1225 adults (530 men; aged 26.3-47.7 years) from the Bogalusa Heart Study with 27.1-year follow-up since childhood. We used 110/70 and 120/80 mm Hg for children (age, 6-11 years), and 120/80 and 130/85 mm Hg for adolescents (age, 12-17 years) as the simplified definition of childhood prehypertension and hypertension, respectively, to compare with the 2004 Fourth Report (the complex definition). Adult carotid intima-media thickness, pulse wave velocity, and left ventricular mass were measured using digital ultrasound instruments. Compared with normal blood pressure, childhood hypertensives diagnosed by the simplified definition and the complex definition were both at higher risk of adult hypertension with hazard ratio of 3.1 (95% confidence interval, 1.8-5.3) by the simplified definition and 3.2 (2.0-5.0) by the complex definition, high pulse wave velocity with 3.5 (1.7-7.1) and 2.2 (1.2-4.1), high carotid intima-media thickness with 3.1 (1.7-5.6) and 2.0 (1.2-3.6), and left ventricular hypertrophy with 3.4 (1.7-6.8) and 3.0 (1.6-5.6). The results were confirmed by reclassification or receiver operating curve analyses. The simplified childhood blood pressure definition predicts the risk of adult hypertension and subclinical cardiovascular disease equally as the complex definition does, which could be useful for screening hypertensive children to reduce risk of adult cardiovascular disease.

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.

Performance of Eleven Simplified Methods for the Identification of Elevated Blood Pressure in Children and Adolescents

The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84-0.98), high sensitivity (0.69-1.00), high specificity (0.87-1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child's absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.