Determination of blood pressure percentiles in normal-weight children: some methodological issues

Area of Science:

• Pediatrics
• Cardiovascular Health
• Biostatistics

Background:

• Childhood blood pressure tracks to adulthood, highlighting the importance of pediatric norms for long-term cardiovascular disease (CVD) prevention.
• The rising prevalence of childhood obesity correlates with increased blood pressure in children.
• Existing pediatric blood pressure norms may not accurately reflect normal-weight populations.

Purpose of the Study:

• To develop updated, sex-specific blood pressure norms for normal-weight children.
• To establish these norms as a function of age and height.
• To compare these new norms with previously established guidelines.

Main Methods:

• Utilized data from 49,967 children from the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (Pediatric Task Force).
• Developed norms specifically for normal-weight children (body mass index <85th percentile).
• Employed and compared polynomial regression, restricted cubic splines, and quantile regression, identifying quantile regression as the best fit model.

Main Results:

• Established sex-specific blood pressure norms for normal-weight children.
• Demonstrated that these norms are a nonlinear function of both age and height.
• Observed that the newly developed norms are generally slightly lower than previous norms that included overweight children.

Conclusions:

• The developed quantile regression models provide refined blood pressure norms for normal-weight children.
• These sex-specific, age- and height-dependent norms are crucial for accurate pediatric hypertension assessment.
• Updated norms are essential for effective early identification and management of cardiovascular risk in children.