A new modified blood pressure-to-height ratio simplifies the screening of hypertension in Han Chinese children

Ma, Chunxiao; Lu, Qiang; Wang, Rui; Liu, Xiaoli; Lou, Dong-Hui; Yin, Fei

doi:10.1038/hr.2016.89

Cited by 10 publications

(18 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 The BPHT formulas were: SBP or DBP The present study described novel cut-off points for BPHT, MBPHT, and NMBPHT, which were built using new guideline data. 6 Consistent with studies based on the former guideline 10 for BP management in children, 4,5 we also showed that NMBPHT had greater performance to detect BP disorders. This superiority can be explained by the better ability of this formula to capture trunk's growth, 5 which is more correlated with BP than whole body's growth.…”

Section: New Modifications Of the Blood Pressure-to-height Ratio For supporting

confidence: 85%

“…The BP-to-height ratio (BPHT) is a simple screening tool that has shown good ability to identify high BP in children. 2 Conversely, variations in this formula, including the modified BP-to-height ratio (MBPHT) 3 and the new modified BP-to-height ratio (NMBPHT), 4,5 have been reported to provide better screening performance than the original BP-to-height ratio. However, a recent guideline changed the BP percentiles values in children and adolescents, 6 virtually nullifying these findings.…”

Section: New Modifications Of the Blood Pressure-to-height Ratio For mentioning

confidence: 99%

See 1 more Smart Citation

New modifications of the blood pressure‐to‐height ratio for the diagnosis of high blood pressure in children

Mourato

Mattos

et al. 2018

J of Clinical Hypertension

View full text Add to dashboard Cite

Section: New Modifications Of the Blood Pressure-to-height Ratio For supporting

confidence: 85%

Section: New Modifications Of the Blood Pressure-to-height Ratio For mentioning

confidence: 99%

New modifications of the blood pressure‐to‐height ratio for the diagnosis of high blood pressure in children

Mourato

Mattos

et al. 2018

J of Clinical Hypertension

View full text Add to dashboard Cite

“…Factors including accuracy, simplicity, cost, and easy use are important for developing a new diagnostic tool for assessing and monitoring BP in pediatrics 4 . As a simplified tool for HBP screening, Modified BPHRs (MBPHR3 and MBPHR7) have been used as alternative methods for HBP screening by considering different heights and BP growth rates in young children 13,16 …”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, Ma et al 16 reported that a new modified BP to‐height ratio MBPHR3 represented as BP/(height + 3 (13‐age) was superior to MBPHR7 in Chinese children for HBP screening.…”

Section: Introductionmentioning

confidence: 99%

Performance of modified blood pressure‐to‐height ratio for diagnosis of hypertension in children: The CASPIAN‐V study

Yazdi

Assadi

Daniali

et al. 2020

J of Clinical Hypertension

View full text Add to dashboard Cite

This study aimed to evaluate the accuracy and performance of modified blood pressure‐to‐height ratio (MBPHR) for identifying high blood pressure (HBP) in a large population of children. This multicentric cross‐sectional study was conducted on a nationally representative sample of 7349 Iranian students aged 7‐12 years living in 30 provinces in Iran. High systolic blood pressure and diastolic blood pressure were defined according to the 2017 American Academy of Pediatrics (AAP) guidelines. The BP‐to height ratio (BPHR) was calculated as BP (mmHg)/height (cm), MBPHR3 as BP (mmHg)/(height (cm) + 3 (13‐age)), and MBPHR7 as BP (mmHg)/(height (cm) + 7 (13‐age). The receiver‐operating characteristic curve analysis was used to evaluate the performance of these three ratios for identification of HBP in children compared to the 2017 AAP guidelines as the gold standard. Mean age of participants was 12.29 ± 3.15 years and 3736 (50.8%) were girls. The prevalence of HBP was 11.9% (11.5% in boys, 12.3% in girls). The area under the curve (AUC) was higher for MSBPHR3/MDBPHR3 (0.97/0.98) than MSBPHR7/MDBPHR7 (0.96/0.97) and SBPHR/DBPHR (0.96/0.95) for identifying high Systolic and diastolic BP. The optimal cut‐off points for MSBPHR3/MDBPH, MSBPHR7/MDBPHR7, and SBPHR/DBPHR were 0.76/0.50, 0.69/0.46, and 0.81/0.52 respectively. Negative predictive value was nearly perfect for three ratios (≥98%). Positive predictive value was higher for MBPHR3 (52.7%) than MBPHR7 (51.0%) and BPHR (39.8%). Overall, MBPHR3 had better performance than MBPHR7 and BPHR for identification of HBP in Iranian children and it may improve early hypertension recognition and control in primary screening.

show abstract

“…The main advantage of these formulas is the simplicity of data needed to evaluate a child's BP status, including only office BP values and height. Although the initial blood‐pressure‐to‐height ratio was appealing in terms of ease to use, the newer modified blood‐pressure‐to‐height ratios [BP/(height (cm) + 7 (13‐age), and BP/(height + 3 (13‐age)] 7,8 may further compel the physician to familiarize and memorize more complex mathematical formulas. This could be a first limitation for their use in clinical practice beyond epidemiological studies, in which statistical formulas facilitate the calculation of the modified ratios.…”

mentioning

confidence: 99%

The challenge of simplifying blood pressure screening in children and adolescents

Stabouli

Antza

Chrysaidou

et al. 2020

J of Clinical Hypertension

View full text Add to dashboard Cite

Simplified methods of blood pressure screening could facilitate the clinical routine of the primary care physicians and may increase adherence to pediatric hypertension guidelines. Blood-pressure-to-height ratios are appealing for the simplicity of data needed to evaluate a child's blood pressure status, including only office blood pressure values and height. In several epidemiological studies around the world bloodpressure-to-height ratios showed good predictive power in identifying children with high blood pressure in terms of area under the curve and sensitivity compared to the gold standard National High Blood Pressure Education Program blood pressure tables, but low positive predictive values meaning a high rate of false-positive cases and possibly increased subsequent work load for primary physicians. Finally, bloodpressure-to height ratios seem to be dependent to age, sex, and weight status. In conclusion, blood-pressure-to-height ratios need to be further improved and validated in different pediatric populations before routine clinical use. | 877 COMMENTARY in terms of area under the curve and sensitivity compared to the gold standard National High Blood Pressure Education Program (NHBPEP) BP tables, 12 but resulted in low positive predictive values (PPV) meaning a high rate of false-positive cases and possibly increased subsequent work load for primary physicians, which is another important limitation for their use in routine BP screening. In this issue Yazdi et al, 6 confirming the results of a previous study by Zhang et al, 13 also found good performance of the blood-pressure-to-height ratios for hypertension screening using the modified NHBPEP normative tables and definitions by the American Academy Pediatrics (AAP) 2017 guideline, but the PPV was low as in previous reports. The blood-pressure-to-height ratios have been previously reported to have good performance against the NHBPEP BP tables. Thus, these results were expected as the new normative tables are in general 2-3 mmHg lower for each hypertension stage according to age, sex, and height category compared to the initial NHBPEP tables included in the Fourth Report and the European Society Hypertension (ESH) 2016 guidelines. 14 Another important finding of the two aforementioned studieswas the different performance of blood-pressure-to-height ratios depending on the participants' ethnicity. This is different than the results of a previous meta-analysis showing that blood-pressure-toheight ratio as screening tool for high BP pressure performed well independent of age, sex, and ethnicity. 10 However, sex is well-known to be a major determinant of BP levels starting from adolescence, 15 and male gender may carry an increased risk for future hypertension. 16,17 The study by Yazdi et al, 6 has also showed that these formulas are age, sex, and weight status dependent. The latter finding highlights the need to validate the blood-pressure-to-height ratios in high-risk populations for hypertension such as overweight and obese children. 18 Of note, if opti...

show abstract

A new modified blood pressure-to-height ratio simplifies the screening of hypertension in Han Chinese children

Cited by 10 publications

References 18 publications

New modifications of the blood pressure‐to‐height ratio for the diagnosis of high blood pressure in children

New modifications of the blood pressure‐to‐height ratio for the diagnosis of high blood pressure in children

Performance of modified blood pressure‐to‐height ratio for diagnosis of hypertension in children: The CASPIAN‐V study

The challenge of simplifying blood pressure screening in children and adolescents

Contact Info

Product

Resources

About