The challenge of simplifying blood pressure screening in children and adolescents

Abstract

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...

Non-linear relationship between sleep duration and blood pressure in children with short stature

“…A growing number of studies have given considerable attention to screening for elevated blood pressure and have confirmed relevant factors in youths, especially in obese children, who are prone to having unfavourable blood pressure levels (4)(5)(6). However, there is increasing evidence that short stature is also a risk factor for CVD, and recent studies have reported that an inverse relationship between height and blood pressure is also exists in children (7,8). Therefore, these studies suggest the need to analyse the blood pressure status and the associated factors, especially in children and adolescents with short stature.…”