Validation of recommended definition in identifying elevated blood pressure in adolescents

Recently, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds for identifying elevated blood pressure (BP) in adolescents aged 13-17 years. The authors aimed to compare the performance of the new definition in identifying elevated BP with traditional percentile-based definition. Data were obtained from the National Health and Nutrition Examination Survey 1999-2014, which included 7485 adolescents aged 13-17 years. Elevated BP was defined using the recommended (≥120/80 mm Hg) and traditional definition (≥90th percentile for sex, age, and height or 120/80 mm Hg) presented in AAP guideline. The prevalence of elevated BP was 15.7% and 17.2% using the recommended and traditional definition, respectively (P < .001). The recommended definition had high sensitivity (90.9%), perfect specificity (100.0%), perfect positive predictive value (100.0%), and very high negative predictive value (98.1%) compared with the traditional definition. The Kappa correlation coefficient between two definitions was 0.94 (P < .001). Similar results can be observed in subgroups across sex, age, and sex- and age-specific height percentile except for both sexes with young age and low height percentile. Generally, our results supported the use of the recommended definition for identifying elevated BP in adolescents.