Height-based equations as screening tools for elevated blood pressure in the SAYCARE study

Area of Science:

• Pediatrics
• Cardiology
• Public Health

Background:

• Elevated blood pressure (BP) in children and adolescents is a growing concern with long-term cardiovascular implications.
• Accurate screening tools are essential for early detection and intervention in pediatric populations.
• Existing screening methods, such as percentile-based charts, can be cumbersome in clinical practice.

Purpose of the Study:

• To evaluate the accuracy of four height-based equations for screening elevated BP in children and adolescents.
• To compare the performance of blood pressure to height ratio (BPHR), modified BPHR (MBPHR), new modified BPHR (NMBPHR), and height-based equations (HBE) against the 2017 clinical guideline.
• To assess the diagnostic agreement of these simplified screening formulas using the kappa coefficient.

Main Methods:

• A cross-sectional study involving 829 children and adolescents from seven South American cities.
• Measurement of height and BP in all participants.
• Receiver operating characteristic (ROC) curve analysis to assess formula performance for diagnosing elevated BP.
• Calculation of sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for each formula.
• Evaluation of diagnostic agreement using the kappa coefficient.

Main Results:

• The height-based equation (HBE) demonstrated 100% sensitivity in children (boys and girls) and high negative predictive values (>99%).
• For adolescents, the new modified BPHR (NMBPHR) achieved 100% sensitivity in both sexes.
• HBE showed the highest agreement with the gold standard diagnostic method (kappa 0.70-0.75), with a notable exception in female children (kappa 0.57).
• Overall, HBE exhibited superior performance compared to other tested formulas in this Latin American pediatric cohort.

Conclusions:

• Height-based equations offer a simplified and potentially more accessible approach to screening for elevated BP in pediatric populations.
• The HBE equation is a promising tool for identifying elevated BP in children and adolescents, demonstrating strong diagnostic accuracy.
• These findings support the utility of simplified, height-based BP screening methods as a practical alternative to traditional percentile charts in resource-limited settings.