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Accuracy of Blood Pressure-to-Height Ratio to Define Elevated Blood Pressure in Children and Adolescents: The CASPIAN-IV Study

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An Erratum to this article was published on 13 January 2016

Abstract

The aim of this study was to propose a simple practical diagnostic criterion for pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group. This study was conducted on a nationally representative sample of 14,880 students, aged 6–18 years. HTN and pre-HTN were defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95 and 90–95th percentile for age, gender, and height, respectively. By using the area under the curve (AUC) of the receiver operator characteristic curves, we estimated the diagnostic accuracy of two indexes of SBP-to-height ratio (SBPHR) and DBP-to-height (DBPHR) to define pre-HTN and HTN. Overall, SBPHR performed relatively well in classifying subjects to HTN (AUC 0.80–0.85) and pre-HTN (AUC 0.84–0.90). Likewise, DBPHR performed relatively well in classifying subjects to HTN (AUC 0.90–0.97) and pre-HTN (AUC 0.70–0.83). Two indexes of SBPHR and DBPHR are considered as valid, simple, inexpensive, and accurate tools to diagnose pre-HTN and HTN in pediatric age group.

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References

  1. Beck CC, Lopes Ada S, Pitanga FJ (2011) Anthropometric indicators as predictors of high blood pressure in adolescents. Arq Bras Cardiol 96:126–133

    Article  PubMed  Google Scholar 

  2. Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Delavari A, Heshmat R, Gouya MM, Razaghi EM, Motaghian M, Mokhtari MR, Barekati H, Arabi MS, CASPIAN Study Group (2006) Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study. Eur J Cardiovasc Prev Rehabil 13:956–963

    Article  PubMed  Google Scholar 

  3. Chen X, Wang Y (2008) Tracking of blood pressure from childhood to adulthood a systematic review and meta-regression analysis. Circulation 117:3171–3180

    Article  PubMed Central  PubMed  Google Scholar 

  4. Chiolero A, Bovet P, Paradis G (2013) Screening for elevated blood pressure in children and adolescents: a critical appraisal. JAMA pediatr 167:266–273

    Article  PubMed  Google Scholar 

  5. Ejike C (2011) Blood pressure to height ratios as simple, sensitive and specific diagnostic tools for adolescent (pre) hypertension in Nigeria. Ital J Pediatr 37:30

    Article  PubMed Central  PubMed  Google Scholar 

  6. Ejike CE, Yin FZ (2013) Blood pressure-to-height ratio simplifies the diagnosis of hypertension in Nigerian children. J Trop Pediatr 59:160–161

    Article  PubMed  Google Scholar 

  7. Falkner B (2010) Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephro 25:1219–1224

    Article  Google Scholar 

  8. Falkner B (2010) Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol 25:1219–1224

    Article  PubMed Central  PubMed  Google Scholar 

  9. Galescu O, George M, Basetty S et al (2012) Blood pressure over height ratios: simple and accurate method of detecting elevated blood pressure in children. Int J Pediatr. 2012:253497

    Article  PubMed Central  PubMed  Google Scholar 

  10. Genovesi S, Antolini L, Giussani M, Pieruzzi F, Galbiati S, Valsecchi MG, Brambilla P, Stella A (2008) Usefulness of waist circumference for the identification of childhood hypertension. J Hypertens 26:1563–1570

    Article  CAS  PubMed  Google Scholar 

  11. Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298:874–879

    Article  CAS  PubMed  Google Scholar 

  12. Kelishadi R (2007) Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev 2007(29):62–76

    Article  Google Scholar 

  13. Kelishadi R, Heshmat R, Motlagh ME, Majdzadeh R, Keramatian K, Qorbani M, Taslimi M, Aminaee T, Ardalan G, Poursafa P, Larijani (2012) Methodology and early findings of the third survey of CASPIAN study: a national school-based surveillance of students’ high risk behaviors. Int J Prev Medi. 3:394

    Google Scholar 

  14. Kelishadi R, Heshmat R, Ardalan G, Qorbani M, Taslimi M, Poursafa P, Keramatian K, Taheri M, Motlagh ME (2014) First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study. J Pediatr 90:85–91

    Article  Google Scholar 

  15. Lawes CM, Vander Hoorn S, Rodgers A (2008) Global burden of blood-pressure-related disease, 2001. Lancet 371:1513–1518

    Article  PubMed  Google Scholar 

  16. Li Z, Snieder H, Harshfield GA, Treiber FA, Wang X (2009) A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood. Hypertens Res 32:404–410

    Article  PubMed Central  PubMed  Google Scholar 

  17. Lu Q, Ma CM, Yin FZ, Liu BW, Lou DH, Liu XL (2011) How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens 25:159–163

    Article  CAS  PubMed  Google Scholar 

  18. Lu Q, Ma C, Yin F, Wang R, Lou D, Liu X (2013) Blood pressure-to-height ratio as a screening measure for identifying children with hypertension. Eur J Pediatr 172:99–105

    Article  PubMed  Google Scholar 

  19. McCrindle BW (2010) Assessment and management of hypertension in children and adolescents. Nat Rev Cardio 7:155–163

    Article  Google Scholar 

  20. Moyer VA (2013) Screening for primary hypertension in children and adolescents: U.S. preventive services task force recommendation statement. Ann Intern Med 159:613–619

    Article  PubMed  Google Scholar 

  21. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  22. Perkins NJ, Schisterman EF (2006) The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163:670–675

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rabbia F, Rabbone I, Totaro S, Testa E, Covella M, Berra E, Bertello MC, Gioia E, Cerutti F, Veglio F (2011) Evaluation of blood pressure/height ratio as an index to simplify diagnostic criteria of hypertension in Caucasian adolescents. J Human Hypertens 25:623–624

    Article  CAS  Google Scholar 

  24. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ (2004) Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 113:475–482

    Article  PubMed  Google Scholar 

  25. Spagnolo A, Giussani M, Ambruzzi AM, Bianchetti M, Maringhini S, Matteucci MC, Menghetti E, Salice P, Simionato L, Strambi MR, Genovesi S (2013) Focus on prevention, diagnosis and treatment of hypertension in children and adolescents. Ital J Pediatr 39:20

    Article  PubMed Central  PubMed  Google Scholar 

  26. Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LM (2014) Hypertension screening using blood pressure to height ratio. Pediatrics 134:e106–e111

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to Ramin Heshmat or Mostafa Qorbani.

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The authors report no conflicts of interest to disclose.

Ethical standard

A comprehensive verbal description of the nature and purpose of the study was given to the students and their parents. Written informed consent was obtained from parents. Ethical committees of Tehran University of Medical Sciences and Isfahan University of Medical Sciences reviewed and approved study protocols.

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Mostafa Qorbani and Ramin Heshmat have contributed equally as corresponding authors.

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Kelishadi, R., Bahreynian, M., Heshmat, R. et al. Accuracy of Blood Pressure-to-Height Ratio to Define Elevated Blood Pressure in Children and Adolescents: The CASPIAN-IV Study. Pediatr Cardiol 37, 378–385 (2016). https://doi.org/10.1007/s00246-015-1287-1

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  • DOI: https://doi.org/10.1007/s00246-015-1287-1

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