Main Article Content
Background Diagnosing hypertension in children and adolescents is not always straightforward. The blood pressure-to-height ratio (BPHR) has been reported as a screening tool for diagnosing hypertension.
Objective To evaluate the diagnostic value of blood pressure-to-height ratio for evaluating hypertension in adolescents.
Methods A cross-sectional study was conducted among 432 healthy adolescents aged 12-17 years in Singkuang, North Sumatera from April to May 2016. Blood pressure tables from the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents were used as our standard of comparison. Sex-specific systolic and diastolic blood pressure-to-height ratios (SBPHR and DBPHR) were calculated. ROC curve analyses were performed to assess the accuracy of BPHR for discriminating between hypertensive and non-hypertensive adolescents. Optimal thresholds of BPHR were determined and validated using 2x2 table analyses.
Results The accuracies of BPHR for diagnosing hypertension were > 90% (P<0.001), for both males and females. Optimal SBPHR and DBPHR thresholds for defining hypertension were 0.787 and 0.507 in boys, respectively, and 0.836 and 0.541 in girls, respectively. The sensitivities of SBPHR and DBPHR in both sexes were all >93%, and specificities in both sexes were all >81%. Positive predictive values for SBPHR and DBPHR were 38.7% and 45.2% in boys, respectively; and 55.9% and 42.4% in girls, respectively; negative predictive values in both sexes were all >97%, positive likelihood ratios in both sexes were all >5, and negative likelihood ratios in both sexes were all <1.
Conclusion Blood pressure-to-height ratio is a simple screening tool with high sensitivity and specificity for diagnosing hypertension in adolescents.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
2. Lu Q, Ma CM, Yin FZ, Liu BW, Lou DH, Liu XL. How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens. 2011;25:159-63.
3. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555-76.
4. Falkner B, Gidding SS, Portman R, Rosner B. Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics. 2008;122:238-42.
5. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. Riset Kesehatan Dasar (Rikesdas) 2013. Available from: http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf
6. National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available from: http://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf.
7. Fitriany J, Ramayati R, Supriatmo, Rusdidjas, Rina O, Siregar R. Blood pressure and lipid profiles in adolescents with hypertensive parents. Paediatr Indones. 2015;55:333-8.
8. Moyer VA, US Preventive Services Task Force. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2013;132:907-14.
9. Lee CG. The emerging epidemic of hypertension in Asian children and adolescents. Curr Hypertens Rep. 2014;16:495.
10. Patel A, Saxena D, Shah H, Sharma V, Singhal D. Impact of weight, height and age on blood pressure among school children. Internet J Fam Pract. 2008;7:1-4.
11. Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LM. Hypertension screening using blood pressure to height ratio. Pediatrics. 2014;134:106-11.
12. Kahn HS, Bain RP, Pullen-Smith B. Interpretation of children’s blood pressure using a physiologic height correction. J Chronic Dis. 1986;39:521–31.
13. Regnault N, Kleinman KP, Rifas-Shiman SL, Langenberg C, Lipshultz SE, Gillman MW. Components of height and blood pressure in childhood. Int J Epidemiol. 2014;1:149-59.
14. LA de Hoog M, van Eijsden M, Stronks K, Gemke RJ, Vrijkotte TG. Association between body size and blood pressure in children from different ethnic origins. Cardiovasc Diabetol. 2012;11:136.
15. Nutton V. Hvdrodvnamics and hydrostatics. In: Bynum WR, Browne EJ, Porter R, editors. Dictionary of the History of Scienee. Princeton: Princeton University Press; 1981.p.193-5.
16. Beck CC, Lopes AS, Pitanga FJ. Anthropometric indicators as predictors of high blood pressure in adolescents. Arq Bras Cardiol. 2011;96:126-33.
17. Dahlan S. Besar sampel dan cara pengambilan sampel. 3rd ed. Jakarta: Salemba Medika; 2013. p. 81-118
18. Azhim A, Akioka K, Akutagawa M, Hirao Y, Yoshizaki K, Obara S, et al. Effect of gender on blood flow velocities and blood pressure: role of body weight and height. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:967-70.
19. Shimamoto K, Ando K, Fujita T, Haseba N, Higaki J, Horiuchi M, et al, on behalf of The Japanese Society of hypertension Committee for Guidelines for the Management of Hypertension. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res. 2014;37:253-392.
20. Alamanda E, Prawirohartono EP, Mulyani NS. Predicting hypertension using waist circumference in obese Indonesian adolescents. Paediatr Indones. 2010;50:300-4.
21. Rizkiriani A, Khomsan A, Riyadi H. Obesity and hypertension among adolescents in Jakarta, Indonesia. Pakistan J Nutr. 2014;13:17-21
22. Juhasz M, Katona E, Settakis G, Paragh G, Molnar C, Fulesdi B, et al. Gender-related differences in adolescent hypertension and in target organ effects. J Women’s Health. 2010;19:759-65
23. Galescu O, George M, Basetty S, Predescu L, Mongia A, Ten S, et al. Blood pressure over height ratios: simple and accurate method of detecting elevated blood pressure in children. Int J Pediatr. 2012;2012:253497.
24. Ahmed A, Ali SW, Massodi S, Bhat MA. Blood pressure-to-height ratio as a screening tool for hypertension in children. Indian Pediatr. 2016;53:137-9.
25. Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat. 2002;246:1-200.
26. Ejike CE, Ugwu CE, Ezeanyika LUS, Olayemi AT. Blood pressure patterns in relation to geographic area of residence: a cross-sectional study of adolescents in Kogi state, Nigeria. BMC Public Health. 2008;8:411. Doi:10.1186/1471-2458-8-411.