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

Ma, Chuanwei; Kelishadi, Roya; Hong, Young Mi; Bovet, Pascal; Khadilkar, Anuradha; Nawarycz, Tadeusz; Krzywińska-Wiewiórowska, Małgorzata; Aounallah-Skhiri, Hajer; Zong, Xin-Nan; Motlagh, Mohammad Esmaeil; Kim, Hae Soon; Khadilkar, Vaman; Krzyżaniak, Alicja; Romdhane, Habiba Ben; Heshmat, Ramin; Chiplonkar, Shashi; Stawińska-Witoszyńska, Barbara; Ati, Jalila El; Qorbani, Mostafa; Kajale, Neha; Traissac, Pierre; Ostrowska-Nawarycz, Lidia; Ardalan, Gelayol; Parthasarathy, Lavanya; Zhao, Min; Xi, Bo

doi:10.1161/hypertensionaha.116.07659

Cited by 33 publications

(21 citation statements)

References 36 publications

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“…To improve the detection of pediatric elevated BP, several simplified definitions were developed . Cross‐sectional studies suggested that those simplified definitions had high sensitivities and moderate specificities in comparison with the Fourth Report .…”

Section: Discussionmentioning

confidence: 99%

Validation of recommended definition in identifying elevated blood pressure in adolescents

Fan

Liu

Zhang

2019

J of Clinical Hypertension

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Adult hypertension is an important public health challenge worldwide due to its high prevalence and its risk for cardiovascular disease (CVD). 1,2 Blood pressure (BP) levels in children and adolescents have been increasing alarmingly during the past decades. 3,4 Elevated BP in children and adolescents may result in target organ damage and increase the risks of adult hypertension and consequent subclinical CVD. [5][6][7][8] Consequently, the early detection of elevated BP in children and adolescents is crucial to promote cardiovascular health and reduce the future CVD risk.The US Fourth Report recommended the sex-, age-, and heightspecific 90th BP percentiles to define pediatric elevated BP, which was accepted worldwide. 9 However, the percentile-based definition included hundreds of abnormal BP cutoff values, which resulted in a complex and cumbersome decision process. Elevated BP in children and adolescents was frequently undiagnosed in the clinical practice. 10,11 As a solution for this problem, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds to identify elevated BP in adolescents aged 13-17 years. 12 The new definition of elevated BP in adolescents was consistent with adult hypertension definition released recently by American College of Cardiology/American Heart Association. 12,13 To our best knowledge, data are presently limited to compare the performance of the new definition in identifying elevated BP and concomitant cardiometabolic risks with the revised sex-, age-, and height-specific pediatric BP standard presented in AAP guideline. AbstractRecently, 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. |FAN et Al. by the US National Center for Health Statistics of the Centers for Disease Control and Prevention since 1999 in 2-ye...

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Section: Discussionmentioning

confidence: 99%

Validation of recommended definition in identifying elevated blood pressure in adolescents

Fan

Liu

Zhang

2019

J of Clinical Hypertension

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“…Simplified criteria have been proposed to ease such burdens. 18,19 However, these simplified criteria still have concerns, such as lack of data in younger children below age 6 and misclassifications; clinical utility of simplified criteria to guide clinical practice is yet to be established in further studies. 6 As electronic healthcare systems are increasingly used, elevated BP in children can be marked with the age-, sex-, and height-specific percentiles integrated into the electronic systems.…”

Section: O M M E N T a R Ymentioning

confidence: 99%

“…Fifth, the current available national or international standards are age, sex, and height specific, resulting in a large number of cutoff points, which are cumbersome in clinical practice. Simplified criteria have been proposed to ease such burdens . However, these simplified criteria still have concerns, such as lack of data in younger children below age 6 and misclassifications; clinical utility of simplified criteria to guide clinical practice is yet to be established in further studies .…”

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confidence: 99%

“…However, similar studies using data from a nationally representative sample will improve generalizability.This study by Fan and colleagues 16 feeds a growing need for examining the performance of different BP standards in predicting adult cardiovascular outcomes. Despite the latest efforts to assess the performance of various standards in identifying high-risk children based on adult subclinical cardiovascular disease, 16,18,19 challenges and knowledge gaps still exist. First, more data that link childhood BP to adult cardiovascular disease events are needed.…”

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confidence: 99%

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Identifying elevated blood pressure and hypertension in children and adolescents

Chen

2018

J of Clinical Hypertension

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A large body of evidence has shown that cardiovascular disease begins in early life, [1][2][3] and multiple cardiovascular risk factors, including elevated blood pressure (BP), exacerbate the effects of age on the progression of cardiovascular disease from childhood to adulthood. 4 Elevated BP in childhood tends to persist into adult life 5 and is the single most significant risk factor for adult hypertension. 6 It also contributes to damages in the cardiovascular system in childhood in the short term 7 and to increased risk of cardiovascular disease in adult life in the long term. 8,9 As a result, the importance of identifying elevated BP and hypertension in children and adolescents has long been recognized. However, how to define elevated BP and hypertension in children and adolescents has been a challenge and remains controversial.Many professional organizations or research groups have developed various criteria for the identification of elevated BP and hypertension in children and adolescents. 6,[10][11][12][13][14][15] The current standards used to define elevated BP in children are mostly determined by age-, sex-, and height-specific percentiles, without reference to adult cardiovascular outcomes because of limited investigations on the performance of the standards in predicting adult cardiovascular events.

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“…15, 16 However, these simplified methods are either still difficult to use or have low positive predictive values compared with the complex definition specific for sex, age and height percentiles. 17–19 …”

Section: Introductionmentioning

confidence: 99%

Can Pediatric Hypertension Criteria Be Simplified?

Zhang

et al. 2017

Hypertension

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Pre-hypertension and hypertension in childhood are defined by sex-, age- and height-specific 90th (or ≥120/80 mmHg) and 95th percentiles of blood pressure (BP), respectively, by the 2004 Fourth Report. However, these cut-offs are complex and cumbersome for use. This study assessed the performance of a simplified BP definition to predict adult hypertension and subclinical cardiovascular disease. The cohort consisted of 1,225 adults (530 males, aged 26.3–47.7 years) from the Bogalusa Heart Study with 27.1 years follow-up since childhood. We used 110/70 and 120/80 mmHg for children (age 6–11 years), and 120/80 and 130/85 mmHg for adolescents (age 12–17 years) as the simplified definition of childhood pre-hypertension and hypertension, respectively, to compare with the 2004 Fourth Report (the complex definition). Adult carotid intima-media thickness (CIMT), pulse wave velocity (PWV), and left ventricular mass were measured using digital ultrasound instruments. Compared to normal BP, childhood hypertensives diagnosed by the simplified definition and the complex definition were both at higher risk of adult hypertension with hazard ratio=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 PWV with 3.5 (1.7–7.1) and 2.2 (1.2–4.1), high CIMT 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 BP 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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Performance of Eleven Simplified Methods for the Identification of Elevated Blood Pressure in Children and Adolescents

Cited by 33 publications

References 36 publications

Validation of recommended definition in identifying elevated blood pressure in adolescents

Validation of recommended definition in identifying elevated blood pressure in adolescents

Identifying elevated blood pressure and hypertension in children and adolescents

Can Pediatric Hypertension Criteria Be Simplified?

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