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Assessing the validity of childhood blood pressure screening: unbiased estimates of sensitivity, specificity, and
M W Gillman1, N R Cook, B Rosner
1Channing Laboratory, Brigham and Women's Hospital, Boston, MA.
Insights
Childhood blood pressure tracking can predict future hypertension risk. This study refines screening accuracy by correcting for measurement variability, improving prediction of adult blood pressure from childhood measurements.
Area of Science:
- Pediatrics
- Cardiovascular Health
- Biostatistics
Background:
- Childhood blood pressure measurement serves as a crucial screening tool for future cardiovascular health.
- Accurate prediction of adult hypertension relies on understanding blood pressure tracking from childhood.
Purpose of the Study:
- To evaluate the accuracy of childhood blood pressure measurements in predicting future blood pressure levels.
- To calculate unbiased estimates of screening test characteristics (sensitivity, specificity, predictive values) using corrected tracking correlations.
Main Methods:
- Utilized data from 333 schoolchildren with multiple blood pressure measurements over 4 years.
- Employed corrected tracking correlations, accounting for within-person variability, to estimate test characteristics.
- Tabulated positive predictive values, sensitivities, and specificities for predicting systolic blood pressure 3 years later.
Main Results:
- Demonstrated the application of corrected tracking correlations for unbiased estimation of screening test performance.
- Provided an example: a 9-year-old male with an average BP of 115 mmHg has a 0.50 probability of true BP >116 mmHg at age 12.
- Highlighted the potential for longer follow-up to determine the accuracy of predicting adult blood pressure from childhood screening.
Conclusions:
- Corrected tracking correlations enhance the accuracy of predicting future blood pressure from childhood measurements.
- This methodology improves the assessment of screening children for hypertension risk.
- Accurate prediction is vital for early intervention and management of potential adult hypertension.
Abstract:
Blood pressure measurement in childhood can be considered as a screening test for future blood pressure levels. Evaluating this test involves calculating sensitivities, specificities, and predictive values for a blood pressure measurement at an initial time for predicting underlying true blood pressure at a subsequent time. We demonstrate the use of childhood blood pressure tracking correlations that are corrected for within-person variability to calculate unbiased estimates of these test characteristics. In a cohort of 333 schoolchildren, we measured blood pressure on multiple visits in each of 4 successive years. Using these data for within-person variances and corrected tracking correlations, and U.S. population data for means and total variances, we tabulated positive predictive values, sensitivities, and specificities for the case of predicting a 9-year-old male's true systolic blood pressure 3 years later. For example, if a 9-year-old's average blood pressure from 4 visits is 115 mmHg, the probability of his true blood pressure being greater than 116 mmHg (90th percentile) at age 12 is 0.50. With longer follow-up, the use of predictive values, sensitivities, and specificities that incorporate corrected correlations should allow determination of the accuracy of predicting adult blood pressure from childhood values, and therefore the usefulness of screening children for those at high risk of developing hypertension.