Abstract
Background: The age, gender, and height, percentiles requirements for the ‘gold-standard’ diagnosis of hypertension and prehypertension in adolescents make it time-consuming for clinicians and difficult-to-use by non-professionals. Simplified diagnostic tools are therefore needed. The use of blood pressure-to-height ratio (BPHR), systolic (SBPHR) and diastolic (DBPHR), has been reported in Han adolescents, and it requires validation in other racial groups. The diagnostic accuracy of SBPHR and DBPHR in Bhavnagar, Gujarat, India was therefore studied. Methods: From a population of 1000 school going Caucasian adolescents aged 12-18 years from two schools; Blood pressures were measured using standard procedures. Hypertension and prehypertension (HTPHT) were defined according to the 2004 Working Group normative tables. ROC curve analyses were used to assess the diagnostic accuracy of BPHR in defining HTPHT in this population. Sex-specific threshold values for SBPHR and DBPHR were determined and thereafter used to define HTPHT. The sensitivity/specificity of this method was determined. Results: The accuracy of SBPHR and DBPHR in diagnosing HTPHT, in both sexes, was >92%. The optimal threshold ratio for prehypertension was 0.725/0.465 in boys and 0.745/0.465 in girls; while for hypertension, they were 0.765/0.495 in boys and 0.795/0.515 in girls. The sensitivity and specificity of this method was >88%. Conclusions: The use of blood pressure-to-height ratio BPHR is valid, simple, and accurate in this population. Keywords: Adolescents; Blood pressure-to-height ratio; Diagnosis; Prehypertension; Hypertension; Bhavnagar; School
Highlights
Hypertension is an emerging health issue of importance in children and adolescents
The inverse correlation between both, SBPHR, DBPHR, and height implies that shorter subjects had relatively higher values while taller subjects had relatively smaller values, ensuring that tall adolescents are not misclassified as hypertensives or short and heavy adolescents are not misclassified as normotensives
The area under the receiver-operating characteristic (ROC) curves found in this study shows that SBPHR and DBPHR have robust discriminatory capacities for diagnosing hypertension
Summary
Hypertension is an emerging health issue of importance in children and adolescents. Because HBP in childhood is often asymptomatic and, is overlooked, almost 75% (90% with prehypertension) remain undiagnosed. We chose to evaluate this approach with following objectives in mind: to validate previous results via a sampling of adolescents from Bhavnagar, Gujarat, India; to determine applicability to children (12 to 18 years of age); to determine optimal ratio cut-off points, and to investigate its utility in pediatric prehypertensive and hypertensive population. The use of blood pressure-to-height ratio (BPHR), systolic (SBPHR) and diastolic (DBPHR), has been reported in Han adolescents, and it requires validation in other racial groups. Sex-specific threshold values for SBPHR and DBPHR were determined and thereafter used to define HTPHT. Conclusions: The use of blood pressure-to-height ratio BPHR is valid, simple, and accurate in this population.
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