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Pollack AH, Hanevold C, Onchiri F, Flynn JT. Influence of Blood Pressure Percentile Reporting on the Recognition of Elevated Blood Pressures. Hosp Pediatr 2021; 11:799-807. [PMID: 34215652 DOI: 10.1542/hpeds.2020-002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the impact of displaying blood pressure (BP) percentiles with BP readings in the electronic health record (EHR) on the recognition of children with elevated blood pressures (EBPs). METHODS This was a retrospective cohort study of children (ages 1-17), including inpatients and outpatients, with at least 1 EHR noninvasive BP recording. In phase 1, BP percentiles were calculated, stored, and not displayed to clinicians. In phase 2, percentiles were displayed adjacent to the EHR BP. Encounters with 1 BP ≥95th percentile were classified as elevated. EBP recognition required the presence of at least 1 EBP-related International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision code. We compared recognition frequencies across phases with logistic regression. RESULTS In total, 45 504 patients in 115 060 encounters were included. Inpatient recognition was 4.1% (238 of 5572) in phase 1 and 5.5% (338 of 5839) in phase 2. The adjusted odds ratio (OR) associated with the intervention was 1.22 (95% confidence interval [CI]: 0.90-1.66). Outpatient recognition rates were 8.0% (1096 of 13 725 EBP encounters) in phase 1 and 9.7% (1442 of 14 811 encounters) in phase 2. The adjusted OR was 1.296 (95% CI: 0.999-1.681). Overall, recognition rates were higher in boys (outpatient OR: 1.51; 95% CI: 1.15-1.98) and older children (outpatient/inpatient OR: 1.08/1.08; 95% CI: 1.05-1.11/1.05-1.11) and lower for those on a surgical service (outpatient/inpatient: OR: 0.41/0.38; 95% CI: 0.30-0.58/0.27-0.52). CONCLUSIONS Addition of BP percentiles to the EHR did not significantly change EBP recognition as measured by the addition of an EBP diagnosis code. Girls, younger children, and patients followed on a surgical service were less likely to have their EBP recognized by providers.
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Affiliation(s)
- Ari H Pollack
- Division of Nephrology .,Seattle Children's Hospital, Seattle, Washington
| | - Coral Hanevold
- Division of Nephrology.,Seattle Children's Hospital, Seattle, Washington
| | | | - Joseph T Flynn
- Division of Nephrology.,Seattle Children's Hospital, Seattle, Washington
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2
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Mann JK, Lutzker L, Holm SM, Margolis HG, Neophytou AM, Eisen EA, Costello S, Tyner T, Holland N, Tindula G, Prunicki M, Nadeau K, Noth EM, Lurmann F, Hammond SK, Balmes JR. Traffic-related air pollution is associated with glucose dysregulation, blood pressure, and oxidative stress in children. ENVIRONMENTAL RESEARCH 2021; 195:110870. [PMID: 33587949 PMCID: PMC8520413 DOI: 10.1016/j.envres.2021.110870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Metabolic syndrome increases the risk of cardiovascular disease in adults. Antecedents likely begin in childhood and whether childhood exposure to air pollution plays a contributory role is not well understood. OBJECTIVES To assess whether children's exposure to air pollution is associated with markers of risk for metabolic syndrome and oxidative stress, a hypothesized mediator of air pollution-related health effects. METHODS We studied 299 children (ages 6-8) living in the Fresno, CA area. At a study center visit, questionnaire and biomarker data were collected. Outcomes included hemoglobin A1c (HbA1c), urinary 8-isoprostane, systolic blood pressure (SBP), and BMI. Individual-level exposure estimates for a set of four pollutants that are constituents of traffic-related air pollution (TRAP) - the sum of 4-, 5-, and 6-ring polycyclic aromatic hydrocarbon compounds (PAH456), NO2, elemental carbon, and fine particulate matter (PM2.5) - were modeled at the primary residential location for 1-day lag, and 1-week, 1-month, 3-month, 6-month, and 1-year averages prior to each participant's visit date. Generalized additive models were used to estimate associations between each air pollutant exposure and outcome. RESULTS The study population was 53% male, 80% Latinx, 11% Black and largely low-income (6% were White and 3% were Asian/Pacific Islander). HbA1c percentage was associated with longer-term increases in TRAP; for example a 4.42 ng/m3 increase in 6-month average PAH456 was associated with a 0.07% increase (95% CI: 0.01, 0.14) and a 3.62 μg/m3 increase in 6-month average PM2.5 was associated with a 0.06% increase (95% CI: 0.01, 0.10). The influence of air pollutants on blood pressure was strongest at 3 months; for example, a 6.2 ppb increase in 3-month average NO2 was associated with a 9.4 mmHg increase in SBP (95% CI: 2.8, 15.9). TRAP concentrations were not significantly associated with anthropometric or adipokine measures. Short-term TRAP exposure averages were significantly associated with creatinine-adjusted urinary 8-isoprostane. DISCUSSION Our results suggest that both short- and longer-term estimated individual-level outdoor residential exposures to several traffic-related air pollutants, including ambient PAHs, are associated with biomarkers of risk for metabolic syndrome and oxidative stress in children.
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Affiliation(s)
- Jennifer K Mann
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Liza Lutzker
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie M Holm
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Helene G Margolis
- Department of Internal Medicine, University of California, Davis, Davis, CA, USA
| | - Andreas M Neophytou
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ellen A Eisen
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Sadie Costello
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Tim Tyner
- University of California, San Francisco-Fresno, Fresno, CA, USA; Central California Asthma Collaborative, USA
| | - Nina Holland
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Gwen Tindula
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Mary Prunicki
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Palo Alto, CA, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Palo Alto, CA, USA
| | - Elizabeth M Noth
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - S Katharine Hammond
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - John R Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Cossio-Bolaños M, Vidal-Espinoza R, de Campos FCC, Sulla-Torres J, Cossio-Bolaños W, Andruske CL, Albornoz CU, Campos RG. Establishing percentiles for blood pressure based on absolute height for children and adolescents. BMC Pediatr 2021; 21:26. [PMID: 33413191 PMCID: PMC7792128 DOI: 10.1186/s12887-020-02489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evaluating blood pressure (BP) is one element for diagnosing and preventing disease in student populations. The objectives of this research were to (a) identify the range of height for measuring BP adjusted for student populations and (b) propose percentiles for evaluating BP based on height. Methods A cross-sectional study was carried out with 3,013 students. Weight, height, and diastolic (DBP) and systolic (SBP) blood pressure were evaluated. Body Mass Index (BMI) was calculated. Height ranges of 5 and 10 cm were generated. Results R2 values for height ranges of 5 cm consisted of [normotensive: DBP (R2 = 10 to 13%) and SBP (R2 = 14 to 20%), and for hypertensive: DBP (R2 = 0.07 to 15%) and for SBP (R2 = 29 to 32%)]. For height ranges of 10 cm, values included: [normotensive: DBP (R2 = 10 to 15%), and SBP (R2 = 15 to 21%) and for hypertensive: DBP (R2 = 0.07 to 16%) and SBP (R2 = 29 to 35%)]. For 5 cm height ranges, diferences occurred between both sexes for DBP (in 5 height ranges from 123 to 148 cm and 158 to 168 cm) and for the SBP (in 6 height ranges from 128 to 148 cm and from 158 to 168 cm). In the 10 cm categories, diferences appeared in DBP (from 138 to 148 cm) and in the SBP (from 158 to 168 cm). Conclusions Height is a determinant for evaluating blood pressure, and height ranges of 10 cm are more suitable for children and adolescents. The proposed percentiles based on height ranges allowed assessment of the DBP and SBP suggest their use in epidemiological and educational contexts.
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Affiliation(s)
| | | | | | | | | | | | - Camilo Urra Albornoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
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Yuan Y, Mu JJ, Chu C, Zheng WL, Wang Y, Hu JW, Ma Q, Wang KK, Yan Y, Liao YY, Chen C. Predictive Role of Child-To-Adult Blood Pressure Trajectories for Incident Metabolic Syndrome: 30-Year Hanzhong Adolescent Hypertension Study. Endocr Pract 2020; 27:433-442. [PMID: 33840450 DOI: 10.1016/j.eprac.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/06/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The relationship between child-to-adult blood pressure (BP) trajectories and metabolic syndrome (MetS) is unknown. We aimed to determine the predictive role of BP trajectories for incident MetS and its components. METHODS The prospective Hanzhong Adolescent Hypertension study began in 1987 and included 2692 participants free of MetS at baseline with at least 3 BP measurements available from 1987 to 2017. RESULTS The systolic BP (SBP) trajectory patterns were grouped as normal (class 1, 18.7%), high normal (class 2, 60.3%), prehypertensive (class 3, 13.1%), stage 1 hypertensive (class 4, 5.7%), and stage 2 hypertensive (class 5, 2.2%). Compared with those in the normal group, individuals in classes 2 to 5 had significantly higher risks of MetS (all Ps < .05), and those with hypertension had more than an 8-fold higher risk of MetS (both P < .05). The fully adjusted risk ratios (RRs) of central obesity increased significantly in a stepwise manner as the SBP trajectory group increased from class 1 to class 5 (P < .05). Compared with those with a normal SBP trajectory, participants in the prehypertensive group and stage 1 and stage 2 hypertensive groups had significantly higher RRs for high-risk triglycerides after full adjustment (RR = 1.89 [1.22-2.94]; RR = 3.61 [2.16-6.02]; and RR = 3.22 [1.52-6.84], respectively). CONCLUSION Our study suggests that BP trajectories are predictive of incident MetS outcomes. Early detection of hypertension or modest elevations in BP is crucial. The stage of hypertension based on SBP level showed a greater association with central obesity.
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Affiliation(s)
- Yue Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Jian-Jun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China.
| | - Chao Chu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Wen-Ling Zheng
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yang Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Jia-Wen Hu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Qiong Ma
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Ke-Ke Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yu Yan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yue-Yuan Liao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Chen Chen
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
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Subjective Proximity to Green Spaces and Blood Pressure in Children and Adolescents: The CASPIAN-V Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:8886241. [PMID: 33381194 PMCID: PMC7748899 DOI: 10.1155/2020/8886241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Evidence favoring a beneficial association between greenness and blood pressure (BP) in adults is accumulating. However, children and adolescents have been understudied accordingly. Methodologically, the data on “exposure” to residential green spaces are commonly satellite-derived, including rare existing studies on the relationship between proximity to green spaces and BP in children. Despite perfectly obliterating subjective biases, remote sensing methods of greenness data collection fail to address pragmatic interaction with such settings. This study aimed to assess the relationship between subjective proximity to green spaces and average/elevated BP in children. Through our study, systolic and diastolic BPs of 12,340 schoolchildren living in CASPIAN-V study areas were examined and recorded. We performed surveys to obtain the data on their proximity to green spaces, defined as having access to such spaces within a 15-minute walk from their homes. Linear mixed-effects models with BP as the outcome variable and the measure of exposure to green spaces as fixed-effect predictor were applied. The analysis was adjusted for several covariates. We found that perceived residential proximity to green spaces was associated with −0.08 mmHg (95% confidence intervals (CIs): −0.58, 0.41; p value = 0.72) reduction in systolic BP and −0.09 (95% CIs: −0.49, 0.31; p value = 0.66) reduction in diastolic BP. We also observed statistically nonsignificant odds ratio of 1.03 (95% CIs: 0.76, 1.39), 0.96 (95% CIs: 0.80, 1.16), and 0.98 (95% CIs: 0.82, 1.16) for isolated systolic/diastolic hypertension and hypertension, respectively. Our observations remained consistent after adjustment for height, parental employment, low birth weight, parental obesity, single parent, and breastfeeding. In conclusion, subjective proximity to green spaces might not be associated with a lower mean BP in children. Well-designed studies applying both subjective and objective data should be performed to elaborate on the relationship further.
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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.
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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
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Simplified blood pressure tables based on different height percentiles for screening elevated blood pressure in children. J Hypertens 2020; 37:292-296. [PMID: 30067249 DOI: 10.1097/hjh.0000000000001880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In 2017, the American Academy of Pediatrics (AAP) updated its clinical practice guideline for screening and management of high blood pressure (BP) in children. In addition, the AAP guideline also recommended a simplified BP table for screening purposes in children aged 1-12 years, which was based on the fifth height percentile. The aim of this study was to assess the performance of the simplified AAP table and six other simplified tables across different height percentiles in predicting elevated BP in US children. METHODS We included 6816 children aged 8-12 years in the National Health and Nutrition Examination Survey (NHANES) in 1999-2016 and 3145 children aged 5-12 years in the NHANES III in 1988-1994. Apart from the AAP simplified table at fifth height percentile, we generated sex and age-specific BP tables to predict elevated BP at the 10th, 25th, 50th, 75th, 90th and 95th percentiles of height, respectively, based on the reference AAP guideline. RESULTS In NHANES 1999-2016, with the height percentile increasing (5th-95th), positive predictive value (PPV) substantially increased (46.9 to 94.0%), while negative predictive value (NPV) slightly decreased (100 to 96.7%); specificity increased (84.4 to 99.3%) while sensitivity decreased (99.9 to 75.7%). The results were similar in NHANES III. CONCLUSION The simplified AAP table could be necessary in clinical practice to avoid omitting any true positive case, but a simplified and more efficient table at a higher height percentile could be more suitable in settings such as school screening programs by nonpaediatricians.
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Use of Static Cutoffs of Hypertension to Determine High cIMT in Children and Adolescents: An International Collaboration Study. Can J Cardiol 2020; 36:1467-1473. [PMID: 32492399 DOI: 10.1016/j.cjca.2020.02.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents. METHODS Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs. RESULTS Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05). CONCLUSION Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.
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Yang L, Kelishadi R, Hong YM, Khadilkar A, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Ekbote V, Zhao M, Heiland EG, Liang Y, Xi B. Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort. Hypertension 2019; 74:1343-1348. [PMID: 31630571 DOI: 10.1161/hypertensionaha.119.13807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.
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Affiliation(s)
- Liu Yang
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Tadeusz Nawarycz
- Department of Biophysics, Medical University of Lodz, Poland (T.N., L.O.-N.)
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health, Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Tunis, Tunisia (H.A.-S.)
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Alicja Krzyżaniak
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia (H.B.R.)
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.)
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit, National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.)
| | - Mostafa Qorbani
- Department of Epidemiology, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M.Q.)
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Pierre Traissac
- Institut de Recherche pour le Développement, UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.)
| | | | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Emerald G Heiland
- Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (E.G.H.)
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (Y.L.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
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10
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Fan H, Liu Y, Zhang X. Validation of recommended definition in identifying elevated blood pressure in adolescents. J Clin Hypertens (Greenwich) 2019; 21:1343-1349. [PMID: 31381261 DOI: 10.1111/jch.13640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Hui Fan
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Yudan Liu
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Xingyu Zhang
- Applied biostatistics laboratory, University of Michigan School of Nursing, Ann Arbor, MI, USA
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11
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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).
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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.
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12
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Ma C, Lu Q, Wang R, Yin F. Using height-corrected definition of metabolic syndrome in children and adolescents. J Pediatr Endocrinol Metab 2019; 32:429-438. [PMID: 31050656 DOI: 10.1515/jpem-2018-0414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/23/2019] [Indexed: 02/06/2023]
Abstract
Metabolic syndrome (MS) is common among children and adolescents. Age- and gender-specific references or age-, gender- and height-specific references were used in pediatric MS definitions. More recently, an increasing number of studies documented that the ratio of waist circumference (WC) to height (WHtR) and blood pressure to height (BPHR) were easy anthropometric indexes for detection of obesity and hypertension in children and adolescents. For these reasons, height-corrected MS definition was proposed. WHtR and BPHR were used as alternatives to WC and BP in the definition of MS. In the present review, we discuss the possibility of the height-corrected MS definition for identifying MS in children.
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Affiliation(s)
- Chunming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fuzai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao 066000, Hebei Province, China, Phone: +86-335-3634208, Fax: +86-335-3032042
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13
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Hypertension Editors' Picks. Hypertension 2019; 73:e67-e82. [PMID: 31030605 DOI: 10.1161/hypertensionaha.119.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Hou Y, Bovet P, Kelishadi R, Litwin M, Khadilkar A, Hong YM, Nawarycz T, Stawińska-Witoszyńska B, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Krzywińska-Wiewiorowska M, Ati JE, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Yang L, Zhao M, Chiolero A, Xi B. Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study. Hypertens Res 2018; 42:845-851. [PMID: 30587855 DOI: 10.1038/s41440-018-0178-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/11/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022]
Abstract
Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.
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Affiliation(s)
- Yaping Hou
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Tadeusz Nawarycz
- Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health (INSP), Nutrition Surveillance and Epidemiology in Tunisia (SURVEN) Research Laboratory, 1002, Tunis, Tunisia
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Alicja Krzyżaniak
- Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - Mostafa Qorbani
- Department of Epidemiology, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Pierre Traissac
- Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France
| | - Lidia Ostrowska-Nawarycz
- Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Lavanya Parthasarathy
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, McGill University, Montreal, Canada
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
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15
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Zhang Y, Yang L, Hou Y, Zhao M, Bovet P, Xi B. Performance of the Simplified American Academy of Pediatrics Table to Screen Elevated Blood Pressure in Children. JAMA Pediatr 2018; 172:1196-1198. [PMID: 30105363 PMCID: PMC6583017 DOI: 10.1001/jamapediatrics.2018.1923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study assesses the performance of the simplified American Academy of Pediatrics table vs the American Academy of Pediatrics guideline for screening children with elevated blood pressure.
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Affiliation(s)
- Yuanyuan Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Yaping Hou
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
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16
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Zhang Y, Yang L, Hou Y, Zhao M, Chiolero A, Bovet P, Xi B. A simple table based on height to assess elevated and high blood pressure in children. J Hum Hypertens 2018; 33:248-254. [PMID: 30401980 DOI: 10.1038/s41371-018-0128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/29/2018] [Accepted: 10/22/2018] [Indexed: 11/09/2022]
Abstract
The 2017 American Academy of Pediatrics (AAP) guideline for assessing "elevated blood pressure (BP) (90th BP percentile)" and "high BP (95th BP percentile)" includes a large number of BP cut-offs based on sex, age and height, which makes it cumbersome to use in clinical practice. We developed and evaluated the performance of a simple table based on a child's height only to assess elevated and high BP in children compared to the reference AAP guideline based on sex, age and height. Data came from 6816 children aged 8-12 years from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2016 and 3145 participants aged 5-12 years from NHANES III (1988-1994). Compared to the reference AAP guideline, the simple table had high values of AUC (0.96/0.91), sensitivity (92.7%/83.2%), specificity (99.0%/99.4%), PPV (92.6%/89.3%), NPV (99.0%/99.0%), and Kappa coefficient (0.92/0.85) for screening elevated/high BP when applied to NHANES, and values were similarly high when applied to NHANES III. These findings show that the simple table based on height only performed nearly as well as the reference 2017 AAP guideline based on sex, age and height for assessing elevated and high BP in U.S. children. This simple table may be a useful screening tool to assess high BP in children aged 5-12 years, particularly in a context of mass screening programs.
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Affiliation(s)
- Yuanyuan Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Yaping Hou
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Arnaud Chiolero
- Institute of Primary Health Care, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Department of Epidemiology, McGill University, Montreal, Canada
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
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17
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Reply. J Hypertens 2018; 36:2480. [PMID: 30379790 DOI: 10.1097/hjh.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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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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19
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Mourato FA, Mattos SS, Lima Filho JL, Mourato MF, Nadruz W. Height-Based Equations Can Improve the Diagnosis of Elevated Blood Pressure in Children. Am J Hypertens 2018; 31:1059-1065. [PMID: 29452343 DOI: 10.1093/ajh/hpy028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/12/2018] [Indexed: 12/16/2022] Open
Abstract
Background High blood pressure (BP) is usually underdiagnosed in children and adolescents, particularly due to its complex diagnosis process. This study describes novel height-based equations for the detection of BP disorders (BP > 90th percentile) and compares the accuracy of this approach with previously described screening methods to identify BP disorders. Methods Height-based equations were built using the 90th percentile values for systolic and diastolic BP and respective height values from the current guideline of high-BP management in children. This guideline was also used as the gold standard method for identification of BP disorders. The equations were tested in Brazilian (n = 2,936) and American (n = 6,541) populations of children with 8-13 years old. Results The obtained equations were 70 + 0.3 × height (in cm) for systolic BP and 35 + 0.25 × height (in cm) for diastolic BP. The new equations presented sensitivity and negative predictive value of near 100% and specificity > 91% and showed higher specificity and positive predictive value when compared with other screening tools. Importantly, height-based equations had greater agreement (kappa coefficient = 0.75-0.81) with the gold standard method than the other methods (kappa coefficient = 0.53-0.73). Further analysis showed that alternative height-based equations designed to identify hypertension (BP ≥ 95th percentile) also showed superior performance (kappa coefficient = 0.89-0.92) compared with other screening methods (kappa coefficient = 0.43-0.85). Conclusions These findings suggest that the use of height-based equations may be a simple and feasible approach to improve the detection of high BP in the pediatric population.
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Affiliation(s)
- Felipe A Mourato
- Laboratório de Imunopatologia Keizo Asami (LIKA), Universidade Federal de Pernambuco, Recife, Brazil
- Científico, Círculo do Coração de Pernambuco, Recife, Brazil
| | - Sandra S Mattos
- Laboratório de Imunopatologia Keizo Asami (LIKA), Universidade Federal de Pernambuco, Recife, Brazil
- Científico, Círculo do Coração de Pernambuco, Recife, Brazil
| | - Jose L Lima Filho
- Laboratório de Imunopatologia Keizo Asami (LIKA), Universidade Federal de Pernambuco, Recife, Brazil
| | - Marianna F Mourato
- Pediatria, Hospital das Clínicas de Pernambuco (HC-UFPE), Recife, Brazil
| | - Wilson Nadruz
- Laboratório de Imunopatologia Keizo Asami (LIKA), Universidade Federal de Pernambuco, Recife, Brazil
- Clínica Médica, Universidade Estadual de Campinas, Campinas, Brazil
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20
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Zhang Y, Ma C, Yang L, Bovet P, Xi B. Performance of modified blood pressure-to-height ratio for identifying hypertension in Chinese and American children. J Hum Hypertens 2018; 32:408-414. [DOI: 10.1038/s41371-018-0056-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/30/2018] [Accepted: 03/02/2018] [Indexed: 11/09/2022]
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21
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Li S, Chen W. Identifying elevated blood pressure and hypertension in children and adolescents. J Clin Hypertens (Greenwich) 2018; 20:515-517. [PMID: 29430812 PMCID: PMC6874101 DOI: 10.1111/jch.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Shengxu Li
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Wei Chen
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
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22
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Screening children for hypertension: the case against. Pediatr Nephrol 2018; 33:93-100. [PMID: 28983708 DOI: 10.1007/s00467-017-3807-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 01/16/2023]
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23
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Di Bonito P, Valerio G, Pacifico L, Chiesa C, Invitti C, Morandi A, Maffeis C, Licenziati MR, Manco M, Miraglia Del Giudice E, Baroni MG, Loche S, Tornese G, Tomat M, de Simone G. A new index to simplify the screening of hypertension in overweight or obese youth. Nutr Metab Cardiovasc Dis 2017; 27:830-835. [PMID: 28755804 DOI: 10.1016/j.numecd.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Hypertension (HTH) is a frequent complication in pediatric obesity. To simplify the screening of HTH in overweight/obese (Ow/Ob) youth, we compared the performance of a new index (High Blood Pressure index, HBPi) with respect to the standard criteria of the IV Report [systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile for age, gender and height]. We also compared the performance of HBPi with other simplified indices such as the BP/height ratio and the absolute height-specific BP thresholds. Ten pediatrics' outpatient centers participating in the "CARdiometabolic risk factors in ITALY study" provided medical records of 4225 Ow/Ob children and adolescents (age 6-16 years). METHODS AND RESULTS Centers were divided into two groups: training set (TS) (n = 2204 participants) and validation set (VS) (n = 2021 participants). The simplified HBPi (mmHg) was: (SBP/2 + DBP/10) - age + (1 × female gender). In the TS, a HBPi value ≥57 mmHg in both children and adolescents had high sensitivity (0.89), specificity (0.97), positive (0.89) and negative (0.97) predictive values in classifying youth at high risk of HTN compared with the IV Report. In the VS, the HBPi showed a better performance than high levels of BP/height ratio and height-specific BP thresholds in classifying individuals at risk of HTN: area under curves 0.95 (0.93-0.96), 0.80 (0.78-0.82), 0.76 (0.74-0.79), respectively; specificities 0.95 (0.94-0.96), 0.69 (0.67-0.72), 0.60 (0.57-0.62), respectively. CONCLUSIONS HBPi, combining SBP and DBP, gender and age, may help pediatricians to implement HTN screening in Ow/Ob youth.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - G Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
| | - L Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - C Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - C Invitti
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan, Italy
| | - A Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - M Manco
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Loche
- Pediatric Endocrine Unit, Pediatric Hospital for Microcitemia, AO Brotzu, Cagliari, Italy
| | - G Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - M Tomat
- Pediatric Unit, AOU Udine, Udine, Italy
| | - G de Simone
- Hypertension Research Center, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. LANCET PUBLIC HEALTH 2017; 2:e375-e386. [PMID: 29253478 DOI: 10.1016/s2468-2667(17)30123-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 06/04/2017] [Accepted: 06/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa. METHODS We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029. FINDINGS We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2-19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2-24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2-6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1-30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1-42·6) versus normal-weight children (5·5%, 3·1-8·4; p<0·0001). INTERPRETATION This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa. FUNDING None.
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25
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Allegaert K, Levtchenko E. Simplified Thresholds for Pediatric (Pre)hypertension: One Approach to Improve Recognition and Outcome. Hypertension 2017; 69:587-588. [PMID: 28223473 DOI: 10.1161/hypertensionaha.116.08883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karel Allegaert
- From the KU Leuven Department of Development and Regeneration, University of Leuven, Belgium (K.A., E.L.); Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands (K.A.); and Department of Pediatrics, University Hospitals Leuven, Belgium (E.L.).
| | - Elena Levtchenko
- From the KU Leuven Department of Development and Regeneration, University of Leuven, Belgium (K.A., E.L.); Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands (K.A.); and Department of Pediatrics, University Hospitals Leuven, Belgium (E.L.)
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26
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Xi B, Zhang T, Li S, Harville E, Bazzano L, He J, Chen W. Can Pediatric Hypertension Criteria Be Simplified? A Prediction Analysis of Subclinical Cardiovascular Outcomes From the Bogalusa Heart Study. Hypertension 2017; 69:691-696. [PMID: 28223474 DOI: 10.1161/hypertensionaha.116.08782] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/08/2016] [Accepted: 01/19/2017] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Bo Xi
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.)
| | - Tao Zhang
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.)
| | - Shengxu Li
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.)
| | - Emily Harville
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.)
| | - Lydia Bazzano
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.)
| | - Jiang He
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.)
| | - Wei Chen
- From the Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China (B.X., T.Z.); and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA (B.X., T.Z., S.L., E.H., L.B., J.H., W.C.).
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27
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Wang LY, Liu Q, Cheng XT, Jiang JJ, Wang H. Blood pressure-to-height ratio as a screening indicator of elevated blood pressure among children and adolescents in Chongqing, China. J Hum Hypertens 2016; 31:438-443. [PMID: 28032627 DOI: 10.1038/jhh.2016.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022]
Abstract
We aimed to evaluate the performance of blood pressure-to-height ratio (BPHR) and establish their optimal thresholds for elevated blood pressure (BP) among children aged 6 to 17 years in Chongqing, China. Data were collected from 11 029 children and adolescents aged 6-17 years in 12 schools in Chongqing according to multistage stratified cluster sampling method. The gold standard for elevated BP was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ⩾95th percentile for gender, age and height. The diagnostic performance of systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) to screen for elevated BP was evaluated through receiver-operating characteristic curves (including the area under the curve (AUC) and its 95% confidence interval, sensitivity and specificity). The prevalence of elevated BP in children and adolescents in Chongqing was 10.36% by SBP and/or DBP ⩾95th percentile for gender, age and height. The optimal thresholds of SBPHR/DBPHR for identifying elevated BP were 0.86/0.58 for boys and 0.85/0.57 for girls among children aged 6 to 8 years, 0.81/0.53 for boys and 0.80/0.52 for girls among children aged 9 to 11 years and 0.71/0.45 for boys and 0.72/0.47 for girls among adolescents aged 12-17 years, respectively. Across gender and the specified age groups, AUC ranged from 0.82 to 0.88, sensitivity were above 0.94 and the specificities were over 0.7. The positive predictive values ranged from 0.30 to 0.38 and the negative predictive values were ⩾0.99. BPHR, with uniform values across broad age groups (6-8, 9-11 and 12-17 years) for boys and for girls is a simple indicator to screen elevated BP in children and adolescents in Chongqing.
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Affiliation(s)
- L Y Wang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Q Liu
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - X T Cheng
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - J J Jiang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - H Wang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
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