Simplified Thresholds for Pediatric (Pre)hypertension: One Approach to Improve Recognition and Outcome.

Abstract

See related article, pp 691–696 The golden standard for prehypertension and hypertension in childhood is based on sex-, age-, and height-specific 90th (or ≥120/80 mm Hg) and 95th percentiles of blood pressure (BP), respectively.1 This reflects the current setting that hypertension definitions in childhood are driven by statistical methods, not by outcome variables. Unfortunately, this golden standard results in 476 sex-, age-, and height-specific cutoffs to assess the 95th percentile of systolic or diastolic BP in children between 1 and 17 years. Consequently, this multivariate approach results in a complex and cumbersome decision process up to the level that diagnoses are commonly not made or result in inaccurate qualification.2 To further illustrate this, the diagnosis of (pre)hypertension was only mentioned in 26% of 507 (pre)hypertension children or adolescents in the medical file in the Hansen study.2 Specific characteristics like the age, height, obesity-related diagnoses, and the magnitude and number of abnormal BP readings improved the odds that the diagnosis was mentioned in the electronic medical file.2 Because of this and similar observations, it is reasonable to search for strategies to improve correct diagnosis and recognition. The development of easier tools to diagnose (pre)-hypertension by simplified thresholds is one of these strategies. In this issue of the journal, Xi et al3 reported on a prediction analysis of adult hypertension and subclinical cardiovascular outcomes (carotid intima–media thickness, pulse wave velocity, left ventricular mass, at the age of 26–48 years) from the Bogalusa Heart Study and, hereby, compared the golden standard percentile approach to a simplified approach. This simplified approach applied age-based thresholds for prehypertension …