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Height-based equations as screening tools for high blood pressure in pediatric practice, the GENOBOX study
Gloria Pérez-Gimeno1, Azahara I Ruperez1, Mercedes Gil-Campos2,3
1Growth Exercise, Nutrition and Development (GENUD) Research group, Universidad de Zaragoza, Instituto de Investigación Sanitartia de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain.
Journal of Clinical Hypertension (Greenwich, Conn.)
|May 21, 2022
Summary
Pediatric hypertension is underdiagnosed due to a lack of clear screening tools. Height-based equations effectively screen for high blood pressure in children, especially those who are overweight or obese.
Area of Science:
- Pediatric Cardiology
- Clinical Pediatrics
- Public Health
Background:
- Hypertension in children is often underdiagnosed due to the absence of standardized, easily applicable screening criteria.
- Current clinical practices rarely involve routine blood pressure measurement in pediatric routine care, contributing to delayed diagnosis.
Purpose of the Study:
- To evaluate the effectiveness of five different equations for screening high blood pressure in children aged 5–18 years.
- To compare the performance of these equations against the American Academy of Pediatrics (AAP) 2017 guidelines for identifying elevated blood pressure.
Main Methods:
- A study involving 1599 children aged 5 to 18 years.
- Analysis of five screening equations: blood pressure to height ratio, modified blood pressure to height ratio, new modified blood pressure to height ratio, new simple formula, and height-based equations.
- Receiver-operating characteristics (ROC) curves were used to assess the performance of each equation in identifying blood pressure above the 90th percentile (P90th).
Main Results:
- All evaluated equations demonstrated strong performance with an area under the curve (AUC) exceeding 0.882.
- The height-based equations exhibited the best overall performance, achieving a positive predictive value (PPV) above 88.2%.
- All equations showed improved PPV in children with overweight or obesity, with height-based equations achieving PPV >90.2% in this subgroup.
Conclusions:
- Height-based equations are recommended for screening elevated blood pressure in children due to their superior positive predictive values.
- These equations demonstrate effectiveness across different sexes, pubertal statuses, and weight categories, including normal weight and overweight/obese children.
- Implementing height-based equations can improve the detection rates of pediatric hypertension, addressing current underdiagnosis challenges.
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