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Use of multiple visits to increase blood pressure tracking correlations in childhood
M W Gillman1, B Rosner, D A Evans
1Channing Laboratory, Department of Medicine, Boston, Massachusetts.
Insights
Childhood blood pressure tracking correlations improve significantly when using multiple weekly measurements. Averaging readings from several visits better predicts adult blood pressure, addressing week-to-week variability in children.
Area of Science:
- Pediatrics
- Cardiovascular Health
- Biostatistics
Background:
- Childhood blood pressure tracking correlations are typically lower than adult values.
- This disparity may stem from unaddressed week-to-week blood pressure variability in children.
Purpose of the Study:
- To investigate the impact of multiple weekly blood pressure measurements on tracking correlations in children.
- To determine if improved tracking estimates can enhance the prediction of adult blood pressure from childhood data.
Main Methods:
- A cohort of 333 schoolchildren (aged 8-15) underwent blood pressure measurements over 4 successive years.
- Four weekly visits per year, with three measurements per visit, were conducted using a random-zero sphygmomanometer.
- Pearson correlation coefficients (r) were calculated for systolic and diastolic blood pressure using varying numbers of weekly visits.
Main Results:
- Blood pressure tracking correlations (r) for both systolic and diastolic pressures increased substantially with the number of weekly visits used (P < .0001).
- For systolic pressure, 3-year tracking r values rose from .45 (1 visit) to .69 (4 visits).
- For diastolic pressure, 3-year tracking r values increased from .28 (1 visit) to .54 (4 visits).
Conclusions:
- Utilizing multiple weekly blood pressure measurements significantly enhances tracking correlation estimates in children.
- These enhanced estimates approximate adult tracking values, suggesting improved prediction of adult blood pressure from childhood measurements.
- Averaging readings from multiple weekly visits is a promising strategy for more accurate childhood blood pressure assessment and prediction.
Abstract:
Previous studies of childhood blood pressure have shown tracking correlations, which estimate the magnitude of association between initial and subsequent measurements, to be lower than corresponding adult values. Inasmuch as this disparity could arise from failing to account for a larger week-to-week variability in children, blood pressure was measured for 4 successive years, on four weekly visits in each year, and with three measurements at each visit, using a random-zero sphygmomanometer, in a cohort of 333 schoolchildren aged 8 through 15 at entry. Ninety percent of subjects had measurements in 1 or more years of follow-up. For all follow-up periods (1, 2, and 3 years from baseline), the Pearson correlation coefficient (r) for both systolic and diastolic blood pressure rose substantially with the number of weekly visits used to calculate each subject's yearly blood pressure (P less than .0001). For systolic pressure, the 3-year r values for 1, 2, 3, and 4 visits were .45, .55, .64, and .69, respectively. For diastolic pressure (Korotkoff phase 4), the corresponding values were .28, .41, .47, and .54. These higher multiple-visit estimates of tracking approximate published adult values and raise the possibility that prediction of adult blood pressure from childhood measurements may be improved by averaging readings from multiple weekly visits.