Diagnostic Effect of the Single BP Cut-Offs for Identifying Elevated BP and Hypertension in Adolescents Aged 13–17 Years
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In contrast to the percentile-based definitions of elevated blood pressure (BP) and hypertension for children and adolescents of all ages in the 2004 fourth report, the 2017 American Academy of Pediatrics (AAP) BP guideline recommends a change to single BP cut-offs for clinical diagnosis (120/< 80–129/< 80 mmHg for elevated BP and ≥ 130/80 mmHg for hypertension) in adolescents aged 13 years and older, and it also recommends researchers using the percentile-based definitions for more precise BP classification. The aim of our study was to assess the diagnostic effect of the single BP cut-offs for identifying adolescent abnormal BP as compared to the 2017 AAP percentile table by sex, age, and height. Data were from 8287 adolescents aged 13–17 years in NHANES 1999–2016 and 1659 adolescents aged 13–17 years in NHANES III (1988–1994). Compared to the 2017 AAP percentile table, the single BP thresholds performed well for identifying elevated BP in adolescents in NHANES 1999–2016/NHANES III, with high values of area under the curve 0.93/0.95, sensitivity 86.7%/89.9%, specificity 100%/100%, positive predictive value (PPV) 100%/100%, negative predictive value (NPV) 98.2%/98.8%, and kappa coefficient 0.92/0.94. The results were similar for identifying hypertension in the two datasets, with especially high PPV 100%/100% and NPV 99.2%/99.2%. However, the sensitivity values of the simple method for identifying hypertension were not satisfactory among girls, younger adolescents, and Hispanic adolescents in both datasets. In conclusion, the single BP cut-offs in general performed similarly well for identifying abnormal BP as compared to 2017 AAP percentile table, but not well in some subgroups.
KeywordsHigh blood pressure Simple method Diagnosis Adolescents
We thank the National Center for Health Statistic of Centers for Disease Control and Prevention for sharing NHANES data.
BX: conception and design, interpretation of data, and revised it critically for important intellectual content; QL: interpretation of data, and drafting the article; YPH, LY analysis of data, and revised the manuscript critically for important intellectual content; MZ, SL: interpretation of data, and revised it critically for important intellectual content. All authors approved the final manuscript and agreed to be accountable for all aspects of the work.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest relevant to this article to disclose.
The study has been approved by institutional committee of Centers for Disease Control and Prevention.
Informed consent was obtained from both the participants and their parents or guardians.
- 7.Kavey REW, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K (2003) American heart association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 107(11):1562–1566. https://doi.org/10.1161/01.Cir.0000061521.15730.6e CrossRefGoogle Scholar
- 8.Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3):e20171904. https://doi.org/10.1542/peds.2017-1904 CrossRefGoogle Scholar
- 9.McQuillan GM, McLean JE, Chiappa M, Corporation H, Lukacs SL (2015) National health and nutrition examination survey biospecimen program: NHANES III (1988–1994) and NHANES 1999–2014. Vital Health Stat 170:1–22Google Scholar
- 10.Kuczmarski RJ, Ogden C, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC Growth Charts for the United States: methods and development. Vital and health statistics Series 11, Data from the national health survey 246:1–190Google Scholar
- 11.Xi B, Zhang T, Li SX, Harville E, Bazzano L, He J, Chen W (2017) Can pediatric hypertension criteria be simplified?: a prediction analysis of subclinical cardiovascular outcomes from the bogalusa heart study. Hypertension 69(4):691–696. https://doi.org/10.1161/Hypertensionaha.116.08782 CrossRefGoogle Scholar
- 12.Xi B, Zong XN, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, Nawarycz T, Krzywinska-Wiewiorowska M, Aounallah-Skhiri H, Bovet P, Chiolero A, Pan H, Litwin M, Poh BK, Sung RYT, So HK, Schwandt P, Haas GM, Neuhauser HK, Marinov L, Galcheva SV, Motlagh ME, Kim HS, Khadilkar V, Krzyzaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawinska-Witoszynska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Zhao M, Zhang T, International Child Blood Pressure References Establishment Consortium (2016) Establishing international blood pressure references among nonoverweight children and adolescents aged 6 to 17 years. Circulation 133(4):398–408. https://doi.org/10.1161/Circulationaha.115.017936 CrossRefGoogle Scholar