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Use of Single Blood Pressure Cutoffs to Determine High Cimt in Children and Adolescents: An International Collaboration Study

34 Pages Posted: 25 Sep 2018

See all articles by Min Zhao

Min Zhao

Shandong University - School of Public Health

Peter H. Whincup

University of London - Population Health Research Institute

Abel López-Bermejo

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Carmelo A. Caserta

Fondazione per la Medicina Solidale

Carla Campos Muniz Medeiros

State University of Paraiba - Department of Public Health

Anastasios Kollias

National and Kapodistrian University of Athens - Department of Medicine

Lucia Pacifico

Sapienza University of Rome - Department of Pediatrics

Thomas Reinehr

University of Witten/Herdecke - Vestische Children's Hospital

Mieczysław Litwin

Children’s Memorial Health Institute

Christopher G. Owen

University of London - St. George's

Judit Bassols

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Elisabetta L. Romeo

Fondazione per la Medicina Solidale

Thacira Dantas Almeida Ramos

Universidade Federal de Campina Grande - Department of Medicine

George S. Stergiou

National and Kapodistrian University of Athens - Department of Medicine

Lili Yang

Shandong University - School of Public Health

Silvia Xargay-Torrent

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Angela Amante

Associazione Calabrese Di Epatologia

Tatianne Moura Estrela

Universidade Federal de Campina Grande - Department of Physiotherapy

Evangelos Grammatikos

General Hospital of Samos - Department of Pediatrics

Yuanyuan Zhang

Shandong University - School of Public Health

Anna Prats-Puig

University of Girona - Department of Physical Therapy

Danielle Franklin de Carvalho

State University of Paraiba - Department of Public Health

Liu Yang

Shandong University - School of Public Health

Gemma Carreras-Badosa

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Mônica de Oliveira Simões

State University of Paraiba - Department of Public Health

Yaping Hou

Shandong University - School of Public Health

Berta Mas-Pares

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Wang Shui

Shandong University - School of Public Health

Teng Guo

Shandong University - School of Public Health

Mingming Wang

Shandong University - School of Public Health

Hua Chen

Shandong University - School of Public Health

Xiaohuan Lou

Shandong University - School of Public Health

Qian Zhang

Zibo Disease Control and Prevention Center

Yanqing Zhang

Zibo Disease Control and Prevention Center

John E. Deanfield

University College London - Institute of Cardiovascular Science

Costan G. Magnussen

University of Tasmania - Menzies Institute for Medical Research

Bo Xi

Shandong University - School of Public Health

More...

Abstract

Background: Pediatric blood pressure (BP) levels are typically assigned to categories when they exceed sex-, age-, and height-specific 90th (elevated) and 95th percentile (high) cutoffs. Given the number of stratum, there are hundreds of cutoffs for defining elevated and high BP that make it cumbersome to use in clinical practice. In 2017 the American Academy of Pediatrics (AAP) recommended simplified cutoffs of ≥120/80 mmHg and ≥130/80 mmHg be used to diagnose elevated BP and high BP, respectively, in clinical practice for adolescents aged 13-17 years. Accordingly, we suggest cutoffs of ≥110/70 mmHg and ≥120/80 mmHg be used for elevated BP and high BP among children aged 6-12 years. The aim of this study was to evaluate the utility of the simplified cutoffs for pediatric BP in determining high carotid intima-media thickness (cIMT) in children and adolescents.    

Methods: Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain and the UK. A total of 4280 children and adolescents aged 6-17 years were included. High cIMT was defined as cIMT ≥sex-, age- and cohort-specific 90th percentile cutoffs. Logistic regression model, receiver operating characteristic (ROC) curve and net reclassification improvement (NRI) methods were used to compare the performance of the simplified definition with three established complex definitions (i.e. 2017 AAP guideline, 2004 Fourth Report, and 2016 international BP references) in determining high cIMT (≥sex-, age- and cohort-specific 90th percentile of cIMT) in children and adolescents.    

Results: Compared with those who had normal BP, participants with high BP defined using either of the three complex definitions or simplified definition had similar odds of high cIMT, with odds ratios and 95% confidence intervals of 1.46 (1.15-1.86), 1.47 (1.10-1.96), 1.42 (1.12-1.80), and 1.65 (1.25-2.17), respectively, after adjustment for sex, age, race/ethnicity, body mass index, high density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of all four high BP definitions in determining high cIMT were further confirmed by area under the ROC curve and NRI methods (all p for difference >0.05).    

Interpretation: The simplified BP definition performed similarly with three complex definitions in determining high cIMT in children and adolescents. The simplified definition offers a similarly accurate but more convenient means to identify pediatric high BP in clinical practice.  

Funding: Dr Bo Xi was supported by the National Natural Science Foundation of China (81673195). Dr. Costan G. Magnussen was supported by a National Heart Foundation of Australia Future Leader Fellowship (100849).

Declaration of Interest: None

Ethical Approval: Each study was approved by the corresponding institutional review board, and written informed consent was obtained from all study participants and their parents or guardians.

Keywords: blood pressure, screening, carotid intima-media thickness, pediatrics

Suggested Citation

Zhao, Min and Whincup, Peter H. and López-Bermejo, Abel and Caserta, Carmelo A. and Muniz Medeiros, Carla Campos and Kollias, Anastasios and Pacifico, Lucia and Reinehr, Thomas and Litwin, Mieczysław and Owen, Christopher G. and Bassols, Judit and Romeo, Elisabetta L. and Almeida Ramos, Thacira Dantas and Stergiou, George S. and Yang, Lili and Xargay-Torrent, Silvia and Amante, Angela and Estrela, Tatianne Moura and Grammatikos, Evangelos and Zhang, Yuanyuan and Prats-Puig, Anna and de Carvalho, Danielle Franklin and Yang, Liu and Carreras-Badosa, Gemma and de Oliveira Simões, Mônica and Hou, Yaping and Mas-Pares, Berta and Shui, Wang and Guo, Teng and Wang, Mingming and Chen, Hua and Lou, Xiaohuan and Zhang, Qian and Zhang, Yanqing and Deanfield, John E. and Magnussen, Costan G. and Xi, Bo, Use of Single Blood Pressure Cutoffs to Determine High Cimt in Children and Adolescents: An International Collaboration Study (August 8, 2018). Available at SSRN: https://ssrn.com/abstract=3228891 or http://dx.doi.org/10.2139/ssrn.3228891

Min Zhao

Shandong University - School of Public Health

Shandong
China

Peter H. Whincup

University of London - Population Health Research Institute

London
United Kingdom

Abel López-Bermejo

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Girona, 17007
Spain

Carmelo A. Caserta

Fondazione per la Medicina Solidale

Pellaro 89134
Italy

Carla Campos Muniz Medeiros

State University of Paraiba - Department of Public Health

Brazil

Anastasios Kollias

National and Kapodistrian University of Athens - Department of Medicine

Greece

Lucia Pacifico

Sapienza University of Rome - Department of Pediatrics

Italy

Thomas Reinehr

University of Witten/Herdecke - Vestische Children's Hospital

Germany

Mieczysław Litwin

Children’s Memorial Health Institute

Poland

Christopher G. Owen

University of London - St. George's

United Kingdom

Judit Bassols

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Girona, 17007
Spain

Elisabetta L. Romeo

Fondazione per la Medicina Solidale

Pellaro 89134
Italy

Thacira Dantas Almeida Ramos

Universidade Federal de Campina Grande - Department of Medicine

Brazil

George S. Stergiou

National and Kapodistrian University of Athens - Department of Medicine

Greece

Lili Yang

Shandong University - School of Public Health

Shandong
China

Silvia Xargay-Torrent

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Girona, 17007
Spain

Angela Amante

Associazione Calabrese Di Epatologia

Viale Merano, 54
Cittanova RC, 89022
Italy

Tatianne Moura Estrela

Universidade Federal de Campina Grande - Department of Physiotherapy

Brazil

Evangelos Grammatikos

General Hospital of Samos - Department of Pediatrics

Greece

Yuanyuan Zhang

Shandong University - School of Public Health

Shandong
China

Anna Prats-Puig

University of Girona - Department of Physical Therapy

Spain

Danielle Franklin De Carvalho

State University of Paraiba - Department of Public Health

Brazil

Liu Yang

Shandong University - School of Public Health

Shandong
China

Gemma Carreras-Badosa

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Girona, 17007
Spain

Mônica De Oliveira Simões

State University of Paraiba - Department of Public Health

Brazil

Yaping Hou

Shandong University - School of Public Health

Shandong
China

Berta Mas-Pares

Hospital of Girona “Dr. Josep Trueta” - Institut d’Investigació Biomédica de Girona (IdIBGi)

Girona, 17007
Spain

Wang Shui

Shandong University - School of Public Health

Shandong
China

Teng Guo

Shandong University - School of Public Health

Shandong
China

Mingming Wang

Shandong University - School of Public Health

Shandong
China

Hua Chen

Shandong University - School of Public Health

Shandong
China

Xiaohuan Lou

Shandong University - School of Public Health

Shandong
China

Qian Zhang

Zibo Disease Control and Prevention Center

Zibo
China

Yanqing Zhang

Zibo Disease Control and Prevention Center

Zibo
China

John E. Deanfield

University College London - Institute of Cardiovascular Science

United Kingdom

Costan G. Magnussen

University of Tasmania - Menzies Institute for Medical Research

Australia

Bo Xi (Contact Author)

Shandong University - School of Public Health ( email )

Shandong
China