Blood pressure to height ratio for screening hypertension among Indonesian adolescents

Partini Pudjiastuti Trihono; Jeanne Laurensie Sihombing; Rismala Dewi

doi:10.14238/pi63.1.2023.7-12

Partini Pudjiastuti Trihono Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo, Jakarta https://orcid.org/0000-0003-2893-6049
Jeanne Laurensie Sihombing Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta
Rismala Dewi Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta

DOI: https://doi.org/10.14238/pi63.1.2023.7-12

Keywords: adolescents; blood pressure to height ratio; hypertension; sensitivity; specificity

Abstract

Background Pediatric hypertension is an emerging health issue due to its increasing prevalence. Age-, gender-, and height-specific blood pressure percentiles have been widely used as a primary tool for detection of hypertension in the pediatric population. However, this method is too complicated to be used in general pediatric practice. The blood pressure to height ratio has been proposed as a practical tool to detect hypertension in children.

Objective To evaluate the accuracy of blood pressure to height ratio to be used as a tool for screening high blood pressure in Indonesian adolescents.

Methods This diagnostic test study using data from the 2013 Indonesia Basic Health Research (Riset Kesehatan Dasar/RISKESDAS) report included 39,057 adolescents aged 15-18 years with complete data on age, gender, weight, height, and blood pressure. Blood pressure values were classified using the 2017 American Academy of Pediatrics (AAP) hypertension clinical guidelines. Blood pressure to height ratio was calculated as mmHg/cm body height. A receiver-operator characteristics (ROC) curve analysis was performed to assess the accuracy of systolic blood pressure to height ratio (SBPHR) and diastolic blood pressure to height ratio (DBPHR) for screening high blood pressure in adolescents. The optimal cut-off points, sensitivity, and specificity of SBPHR and DBPHR were calculated.

Results The optimal cut-off points for defining elevated blood pressure in male adolescents aged 13-18 years were SBPHR 0.69 for male adolescents (sensitivity 96%, specificity 80%) and DBPHR 0.46 (sensitivity 97%, specificity 84%). In female adolescents, the optimal cut-offs were SBPHR 0.72 (sensitivity 97%, specificity 82%) and DBPHR 0.48 (sensitivity 98% and specificity 79%).

Conclusion Blood pressure to height ratio is a practical method with high sensitivity and specificity for detecting elevated blood pressure in Indonesian adolescents aged 15 to 18 years.

References

1. 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. PMID: 15286277.
2. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904. DOI: https://doi.org/ 10.1542/peds.2017-1904.
3. Fujita Y, Kouda K, Nakamura H, Nishio N, Takeuchi H, Iki M. Relationship between height and blood pressure in Japanese schoolchildren. Pediatr Int. 2010;52:689-93. DOI: https://doi.org/10.1111/j.1442-200X.2010.03093.x.
4. Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. 2002;40:441-7. DOI: httpts://doi.org/ 10.1161/01.hyp.0000032940.33466.12.
5. Bourgeois B, Watts K, Thomas DM, Carmichael O, Hu FB, Heo M, et al. Associations between height and blood pressure in the United States population. Medicine (Baltimore). 2017; 96:e9233. DOI: https://doi.org/ 10.1097/MD.0000000000009233.
6. Bassareo PP, Mercuro G. Pediatric hypertension: an update on a burning problem. World J Cardiol. 2014;6:253-9. DOI: https://doi.org/ 10.4330/wjc.v6.i5.253.
7. Lee CG. The emerging epidemic of hypertension in Asian children and adolescents. Curr Hypertens Rep. 2014;16:495-8. DOI: https://doi.org/10.1007/s11906-014-0495-z
8. Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI. Riset Kesehatan Dasar RISKESDAS 2013. [cited 2018 March 22]. Available from: https://pusdatin.kemkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf.
9. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475-82. DOI: https://doi.org/ 10.1542/peds.113.3.475.
10. Guo X, Zheng L, Li Y, Zhang X, Yu S, Sun Y. Blood pressure to height ratio: a novel method for detecting hypertension in paediatric age groups. Paediatr Child Health. 2013;18:65-9. DOI: https://doi.org/ 10.1093/pch/18.2.65.
11. Ramayani OR, Lubis M, Ambarita K. Nilai diagnostik rasio tekanan darah terhadap tinggi badan dalam diagnosis hipertensi pada remaja. [cited 2018 November 13]. Available from: https://repositori.usu.ac.id/handle/123456789/43482?show=full.
12. Tim Teknis Riskesdas, Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI. Protokol Riset Kesehatan Dasar RISKESDAS 2013. [cited 2018 April 22]. Available from: http://biofarmaka.ipb.ac.id/biofarmaka/2014/Riskesdas2013%20-%20Protocol.pdf.
13. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298:874-9. DOI: https://doi.org/ 10.1001/jama.298.8.874.
14. Rabbia F, Rabbone I, Totaro S, Testa E, Covella M, Berra E, et al. Evaluation of blood pressure/height ratio as an index to simplify diagnostic criteria of hypertension in caucasian adolescents. J Hum Hypertens. 2011;25:623-4. DOI: https://doi.org/ 10.1038/jhh.2011.32.
15. Ejike CE. Blood pressure to height ratios as simple, sensitive and specific diagnostic tools for adolescent (pre)hypertension in Nigeria. Ital J Pediatr. 2011;37:30. DOI: https://doi.org/ 10.1186/1824-7288-37-30.
16. Galescu O, George M, Basetty S, Predescu I, 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. DOI: https://doi.org/10.1155/2012/253497
17. Kelishadi R, Heshmat R, Ardalan G, Qorbani M, Taslimi M, Poursafa P, et al. First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the Caspian-III study. J Pediatr (Rio J). 2014;90:85-91. DOI: https://doi.org/ 10.1016/j.jped.2013.06.005.
18. Mafuta-Munganga D, Lupenzi-Masikini BL, Bayauli-Mwasa P, Kasiam-Lasi-On'Kin JB, Bidingija-Mabika J, Ditu-Mpandamadi S, et al. Blood pressure-to-height ratios can identify hypertension in Bantu young adults from Kinshasa in Democratic Republic of Congo. Eur J Preventive Med. 2021;9:46-50. DOI: https://doi.org/10.11648/j.ejpm.20210902.13.
19. Col N, Kilinc A, Demircioglu-Kilic B, Aydin N, Keskin M, Balat A. Predictive value of the blood pressure to height ratio in diagnosis of prehypertension and hypertension during childhood in Southeastern Turkey. Clin Exp Hypertens. 2019;41:14-9. DOI: https://doi.org/10.1080/10641963.2018.1433198
20. Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LM. Hypertension screening using blood pressure to height ratio. Pediatrics. 2014;134:e106-11. DOI: https://doi.org/ 10.1542/peds.2014-0643.
21. Ladapo TA, Fajolu IB, Adeniyi OF, Ekure EN, Maduako RT, Jaja TC, et al. Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents. Niger J Clin Pract. 2016;19:401-6. DOI: https://doi.org/10.4103/1119-3077.179289.
22. Alpert BS, Quinn D, Gallick D. Oscillometric blood pressure: a review for clinicians. J Am Soc Hypertens. 2014;8:930-8. DOI: https://doi.org/10.1016/j.jash.2014.08.014.