Abstract
BackgroundThe goal was to develop familiar blood pressure (BP) charts representing BP percentile curves similar to CDC growth charts to improve screening of both high and low BP in children.MethodsSince height accounts for substantially more BP variability than age and is a more direct measure of body size and maturation in children, height-specific BP percentile curves were drawn separately for males and females. We used the 2004 Fourth Report data source and equations to calculate the BP threshold value for each gender and 5 cm height group. By slightly underestimating a child’s BP percentile for high BP and slightly overestimating a child’s BP percentile for low BP, these charts guarantee 100 % sensitivity in detecting abnormal BP. Sensitivity and specificity of the chart cut-offs were confirmed in a sample of 1254 healthy children from a school-based blood pressure screening program.ResultsThe 1st, 5th, 25th, 50th, 75th, 90th, 95th, and 99th BP percentile curves are depicted in the chart for each corresponding gender and height from 85 to 190 cm, mimicking the ubiquitous CDC “growth charts”. Shaded areas of the chart differentiate abnormal BP status categories: hypotension, normal BP, prehypertension, Stage 1 hypertension, and Stage 2 hypertension. Sensitivity was confirmed to be 100 % with specificity above 94 %.ConclusionsThese simplified BP charts improve upon currently available BP screening reference with the following features: (a) tracking BP longitudinally in an individual child, (b) full physiological range of BP percentiles represented in percentile curve format for rapid identification both high and low BP, (c) easy to use with absolute height alone avoiding the additional step of determining height percentile, (d) incorporation of adult threshold for pre-hypertension to assist in accurate transition from adolescence into adulthood, (e) high sensitivity and specificity to ensure all children at risk are identified with very few false positives.
Highlights
The goal was to develop familiar blood pressure (BP) charts representing BP percentile curves similar to Center Of Disease Control (CDC) growth charts to improve screening of both high and low BP in children
Color coded areas identifying abnormal high and low blood pressure are included in the BP charts
The calculation of height percentile is not required before using our BP charts as is with the Fourth Report tables
Summary
The goal was to develop familiar blood pressure (BP) charts representing BP percentile curves similar to CDC growth charts to improve screening of both high and low BP in children. The implementation of a simple graphical representation of a child’s BP percentile similar to growth charts currently used for height, weight, BMI, and head circumference would improve and streamline pediatric primary care. Height (stature), rather than age, is a better primary reference metric because it is a more precise measure of body size and maturation which are the primary determinants of the natural rise of BP throughout childhood [16,17,18]. None of these published BP charts depict lower BP thresholds below the 50th percentile
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