Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years

Abstract

Background Several distributions of country-specific blood pressure (BP) percentiles by sex, age and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limit international comparisons of prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents using seven nationally representative data (China, India, Iran, Korea, Poland, Tunisia and USA). Methods and Results Data on BP for 52,636 non-overweight children and adolescents aged 6–19 years were obtained from seven large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and USA. BP values were obtained with certified mercury sphygmomanometers in all seven countries, using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th and 99th) by age and height were estimated using the Generalized Additive Model for Location Scale and Shape (GAMLSS) model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. Compared to BP level of the 90th and 95th percentiles of the U.S. Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower while diastolic BP was similar. Conclusions These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help identify hypertensive youths in diverse populations.

National Blood Pressure Reference for Chinese Han Children and Adolescents Aged 7 to 17 Years

“…29–32 A previous study indicated that the influence of height on BP may even be greater than age. 33 Because of the important determination of body size to BP in children and adolescents, the new national Chinese guidelines were developed to provide specific percentiles of SBP and DBP by age, sex, and height percentiles, 6, 16, 29, 34, 35 similar to the U.S. reference in 2004, Canada’s 2016 guidelines, and the European 2009/2016 guidelines. The U.S. reference has been used by many Chinese researchers and widely internationally.…”

“…39, 40 Third, the study methods only chose Korotkoff phase 5 (K5; the disappearance of the sound) to assess DBP in children without using Korotkoff phase 4 (K4; the muffling of the sound). However, a large number of current pediatric BP references recommend the use of K5, such as the U.S. reference, 16 the international BP reference, 34 the 2009 and 2016 guidelines the European Society of Hypertension 6, 25 and the 2014 recommendation of the American Heart Association 41 as well as the 2016 Canadian guidelines. 42 In addition, K5 has been recommended and universally used to measure DBP in adults.…”

What’s new in paediatric hypertension?

“…This allows accurate comparison in a homogeneous population. Xi et al 19 recently published a paper aiming to provide globally unified reference ranges for paediatric BP based on data from seven large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia and the USA. Of note, overweight and obese children were excluded from the data set, and the BP value recorded was a mean of several readings (minimum of two).…”

Recommended Standards For Assessing Blood Pressure In Human Research Where Blood Pressure Or Hypertension Is A Major Focus

“…Blood pressure in children is preferred to be assessed using manual devices with auscultation, and interpreted using blood pressure percentiles/Z-scores based on appropriate pediatric normative data [7,[27][28][29][30]. An upper arm cuff with the length of the cuff's bladder at least 80% of the arm circumference and the width at least 40% of the arm circumference must be used, and the criteria for selecting an appropriately sized cuff is indicated.…”

“…Blood pressure in children is preferred to be assessed using manual devices with auscultation, and interpreted using blood pressure percentiles/Z-scores based on appropriate pediatric normative data [7,[27][28][29][30].…”