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

Abstract

We sought to develop and validate a national blood pressure reference based on age, sex, and height for Chinese children. Data were obtained on 197,430 children aged 7–17 who participated in the Chinese National Survey on Students’ Constitution and Health in 2010. Blood pressure percentiles were estimated and fitted using the Lambda Mu and Sigma method and then compared to a U.S. reference and China’s existing reference. In an external independent validation sample of 59,653 children aged 7–18 from 7 Chinese provinces in 2013, the prevalence of elevated Blood pressure was compared applying the three references. Blood pressure values were similar for boys and girls at the younger ages (7–13 years) and lower height percentiles, while higher at the older ages (14–17 years) for boys than girls. At medial height in boys and girls aged 7–13, the 50th, 90th, 95th, and 99th percentiles of Blood pressure for the new national reference were consistent with U.S. reference and lower than current Chinese reference. In the independent sample, elevated Blood pressure prevalence, based on the new national reference, ranged from 7.8% to 18.5% among children aged 7–17, which was higher than the U.S. reference values (4.3% to 14.5%) and lower than the current Chinese reference (12.9% to 25.5%) in each age group. The new national Blood pressure reference for Chinese children based on age, sex and height from large-scale and nationally representative data appears to improve the ability for identifying Chinese hypertensive children and for stratifying them with regard to cardiovascular risk.

Identifying elevated blood pressure and hypertension in children and adolescents

“…21 Second, although harmonized, cross-population standards may facilitate comparisons of results across populations, such standards may, to different degrees, misclassify BP status in different populations. 10,15 It has been well documented that significant ethnic and geographic differences exist in BP levels, cardiovascular disease spectrum, and the association of childhood BP with adult cardiovascular risk. [22][23][24][25] Consequently, population-specific standards may be more appropriate in identifying elevated BP or hypertension in children and adolescents.…”

“…In addition, assessing subtle changes in the cardiovascular system in children by noninvasive technologies should also be informative . Second, although harmonized, cross‐population standards may facilitate comparisons of results across populations, such standards may, to different degrees, misclassify BP status in different populations . It has been well documented that significant ethnic and geographic differences exist in BP levels, cardiovascular disease spectrum, and the association of childhood BP with adult cardiovascular risk .…”

“…Of note, developing national references should be based on normal weight samples, as has been done for the development of the updated US standards Nationally representative samples should also be used. Developing national references should ideally be coordinated and done by an authoritative organization; otherwise, discrepancies and confusions may arise even for a single country . Third, all of the current BP standards have been developed based on BP measurements at a single visit, mostly by the auscultatory method.…”

“…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.In this issue of the Journal, Fan and colleagues from the Beijing BP Cohort Study examined the performances of different standards in identifying childhood elevated BP and hypertension and in predicting adult hypertension and subclinical cardiovascular diseases. 16 Left ventricular mass index, carotid-femoral pulse wave velocity, and carotid intima-media thickness were measured in a population-based, longitudinal cohort of 1177 participants who were examined for cardiovascular risk factors in childhood and the subclinical outcomes in young adult life.…”

“…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.…”