Improving Hypertension Screening in Childhood Using Modified Blood Pressure to Height Ratio

Dong, Bin; Wang, Zhiqiang; Wang, Haijun; Ma, Jun

doi:10.1111/jch.12712

Cited by 7 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies that compared the efficacies of different BPHR indices on identification of HBP in children have produced discrepant results 13‐17 . The findings in our study are consistent with the study reported by Zhang et al 17 In their study, the authors compared the efficacy of MBPHR3 and MBPHR7 with BPHR3 in young American and Chinese children and found MBPHR3 had a better predictive performance in identifying HBP compared to BPHR and MBPHR7, but only in American children but not in Chinese children, in whom the MBPHR7 achieved better performance than BPHR and MBPHR3 17 …”

Section: Discussionsupporting

confidence: 83%

“…In a study by Ma et al 14 on hundred Chinese children aged between 7 and 12 years, MBPHR3 showed an acceptable performance compared with MBPHR7 and BPHR.…”

Section: Discussionmentioning

confidence: 94%

“…Mourato et al, 11 recently reported that the modified blood pressure‐to‐height ratio (MBPHR7), calculated as BP/(height (cm) + 7 (13‐age) yields better sensitivity and specificity than BPHR for identifying HBP in 5‐12 years Brazilian children. Similarly, Dang et al reported that MBPHR7 generally performed better than BPHR in the discrimination of BP abnormalities in the young Chinese children 14,15 …”

Section: Introductionmentioning

confidence: 91%

“…MSBPHR7 and NDBPHR were calculated as SBP/(height + 7(13‐age) and DBP/(height + 7 (13‐age) respectively 13 . MSBPHR3 and MDBPR3 were measured as SBP/(height + 3(13‐age) and as DBP/(height + 3(13‐age) respectively 14 . Height is measured in centimetres in all of these ratios.…”

Section: Definitionsmentioning

confidence: 99%

See 3 more Smart Citations

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

Section: Discussionsupporting

confidence: 83%

“…In a study by Ma et al 14 on hundred Chinese children aged between 7 and 12 years, MBPHR3 showed an acceptable performance compared with MBPHR7 and BPHR.…”

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 91%

Section: Definitionsmentioning

confidence: 99%

See 2 more Smart Citations

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

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

Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis

et al. 2016

View full text Add to dashboard Cite

The aim of this study was to assess the performance of the blood pressure-to-height ratio (BPHR) for screening elevated blood pressure (BP) in children and adolescents using a meta-analysis of eligible published studies. We retrieved studies that investigated the performance of the BPHR for identifying elevated BP from Pubmed and other databases. We performed meta-analyses by subgroups of sex, age and ethnicity using a fixed or random effect model based on whether there was between-study heterogeneity. A total of 13 publications including 262 830 children and adolescents aged 6-18 years on BPHR and a total of three publications including 95 343 children on the modified BPHR were included in this meta-analysis. The summary results suggested that BPHR performed well to identify pre-high BP and high BP for children aged 6-11 years and adolescents aged 12-18 years. The performance of BPHR was perfect for identifying severe high BP in adolescents aged 12-18 years. However, the modified BPHR did not improve accuracy for screening high BP in children aged 6-12 years. In summary, BPHR performed well for identifying elevated BP in children and adolescents, independently of sex, age and ethnicity group. In addition, the modified BPHR performed similarly with BPHR for screening high BP in childhood.

show abstract

Improving Hypertension Screening in Childhood Using Modified Blood Pressure to Height Ratio

Cited by 7 publications

References 21 publications

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

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

Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis

Contact Info

Product

Resources

About