Height-Based Equations Can Improve the Diagnosis of Elevated Blood Pressure in Children. (14th February 2018)

• Record Type: Journal Article
• Authors: Mourato, Felipe A; Mattos, Sandra S; Lima Filho, Jose L; Mourato, Marianna F; Nadruz, Wilson
• Is Part Of: American journal of hypertension. Volume 31:Number 9(2018:Sep.)
• Page Start: 1059
• Page End: 1065
• Publication Date: 2018-02-14
• Subjects: blood pressure -- diagnosis -- height -- hypertension -- screening -- pediatrics; Hypertension -- Periodicals; 616.132005
• DOI: 10.1093/ajh/hpy028
• Languages: English
• ISSNs: 0895-7061

Abstract

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.