Abstract
BackgroundThe predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. We aimed to evaluate it based on Health Promotion Program for Children and Adolescents (HPPCA), a school-based surveillance conducted from 2012 to 2018 in Suzhou, China.MethodsA total of 330,618 participants had BP measurement in 2018 and ≥ 3 BP records during 2012–2017, were recruited from HPPCA. Absolute BP values (in mmHg) were converted into age-, sex- and height- normalized z-scores. VVV was expressed as standard deviation (SD), coefficient of variation (CV) or average real variability (ARV) of BP z-scores during 2012–2017. Logistic regression models were used to assess the associations between VVV and HBP in 2018.ResultsIn 2018, 42,554 (12.87%) subjects were defined as HBP. VVV, except for SBP-CV and DBP-CV, was significantly higher in the HBP group than normotensives group. After adjusting for covariates including mean BP values from 2012 to 2017, SBP-SD, SBP-ARV, DBP-SD and DBP-ARV, increased the risk of HBP by 5.70 [95% confidence interval (95% CI) 5.54–5.87], 4.10 (95% CI 4.01–4.20), 4.70 (95% CI 4.50–4.90) and 3.39 (95% CI 3.28–3.50) times, respectively. Notably, SBP-SD significantly improved risk discrimination of HBP based on other risk variables (c-statistics, net reclassification index and integrated discrimination improvement significantly increased).ConclusionsHigher SD or ARV of BP, was independently related with higher probability of HBP in Chinese pediatric population. SBP-SD could be potentially helpful for detecting HBP. Future researches investigating the predictive value of VVV are warrant.
Highlights
The predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled
Utilizing data of Suzhou Health Promotion Program for Children and Adolescents (HPPCA), the present study aimed to examine the associations between VVV and risk of HBP, and investigate whether any VVV indices was capable of improving risk discrimination for HBP in a large-scale Chinese pediatric population
After excluding participants with BP recordings < 3 during 2012–2017 (n = 345,084) and who were defined as HBP at first attendance of HPPCA (n = 13,299), a total of 330,618 participants were eventually included in the analysis
Summary
The predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. High blood pressure (HBP) or hypertension is a serious public health problem worldwide [1], especially in China that possesses the largest population [2]. As a typical type of BPV, Wang et al BMC Cardiovasc Disord (2021) 21:141 visit-to-visit BP variability (VVV) was demonstrated not to be random, but significantly reproducible over a long period of follow-up [9]. Ample evidence indicated that higher VVV was associated with the development, progression and severity of vascular, cardiac and renal target-organ damage, and with an increased risk of cardiovascular events and cardiovascular and all-cause mortality, independent of average BP values [10,11,12]. VVV was promising in facilitating risk classification for further cardiovascular disease [15]
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