Blood pressure reference curves by age and residential altitude in Peruvian adults.

Q: What are the key findings of this study?

Higher altitude of residence was associated with less pronounced age-related increases in blood pressure, resulting in systematically lower systolic blood pressure at older ages compared with residents at lower altitudes.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Blood pressure distribution (n=227093). Intervention: Higher altitude of residence (≥2500 m.a.s.l.) vs. Lower altitude of residence (<2500 m.a.s.l.). Primary outcome: Blood pressure (MAP, DBP, SBP) percentile curves by age and altitude.

Q: What does this research mean for the field?

Higher altitude of residence is associated with less pronounced age-related increases in blood pressure, resulting in systematically lower systolic blood pressure at older ages compared with low-altitude residents. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Akram Hernández-Vásquez; Jamee Guerra Valencia; Rodrigo Vargas‐Fernández

doi:10.47487/apcyccv.v7i1.596.

June 4, 2026

Blood pressure reference curves by age and residential altitude in Peruvian adults.

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Key result

Higher altitude of residence linked to blunted age-related BP increases and lower older-age SBP.

n=227,093

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Why the study?

Age-specific percentile reference curves for mean, diastolic, and systolic blood pressure stratified by residential altitude were needed for Peruvian adults.

Key Points

To develop age-specific percentile reference curves for mean arterial pressure (MAP), diastolic blood pressure (DBP), and systolic blood pressure (SBP) stratified by residential altitude in Peruvian adults aged 20-59 years.
Analyzed data from N=227,093 adults aged 20-59 years with two valid blood pressure measurements and no prior hypertension diagnosis from the Peruvian Demographic and Family Health Survey (ENDES) 2014-2024.
Categorized residential altitude into three strata: <2500, 2500-3499, and ≥3500 meters above sea level (m.a.s.l.).
Modelled BP percentiles (P5 to P95) using generalized additive models for location, scale, and shape (GAMLSS) with a Box-Cox Cole and Green (BCCG) distribution.
MAP, DBP, and SBP showed progressive increases between ages 20 and 50 across all altitudes, but the magnitude of increase diminished with higher elevation; between ages 20 and 50, median SBP increased from 111.1 to 120.9 mmHg at <2500 m.a.s.l., 110.9 to 118.3 mmHg at 2500-3499 m.a.s.l., and 110.4 to 116.4 mmHg at ≥3500 m.a.s.l.
Beyond age 50, DBP and MAP exhibited relative stabilization across all altitudes, whereas SBP continued to increase more gradually through age 59.
At ages 50 and 59, SBP values across all percentiles were systematically lower among residents at ≥3500 m.a.s.l. compared with those at <2500 m.a.s.l.

Study Design

Type

Cross-Sectional (n=227,093)

Multicenter

Yes

Structured PICO

P

Population

227,093 Peruvian adults aged 20-59 years without prior hypertension, assessed cross-sectionally to develop blood pressure percentile curves stratified by altitude.

O

Outcome

Age-specific percentile curves (P5-P95) for mean arterial pressure (MAP), diastolic blood pressure (DBP), and systolic blood pressure (SBP) stratified by altitude of residence (<2500, 2500-3499, and ≥3500 m.a.s.l.)surrogate

Age-related increases in blood pressure are less pronounced in adults residing at higher altitudes in Peru, emphasizing the need for contextualized blood pressure interpretation in high-altitude populations.

Limitations

Cross-sectional design precludes distinguishing physiological aging from generational differences.
Exclusion of individuals with prior hypertension limits generalizability and may underestimate true BP levels.
Self-reported prior hypertension and pregnancy status may introduce misclassification bias.
Lack of information on duration of residence at altitude or migration history.
Combining data from multiple years assumes temporal stability in BP patterns.
Potential variability in measurement technique across different periods and interviewers.
Altitude measurement based on cluster centroid may misclassify exposure.
Analysis did not incorporate sampling weights or complex survey design features in GAMLSS modeling.
Smaller sample sizes at the extremes of the age range in higher altitude strata may affect extreme percentile stability.
Cross-sectional design precludes distinguishing physiological ageing processes from generational differences.
Exclusion of individuals with prior hypertension limits generalisability to the broader adult population.
Prior hypertension and pregnancy status were based on self-report, potentially introducing misclassification bias.
Information on duration of residence at altitude or migration history was not available.
Analysis did not incorporate sampling weights or complex survey design features of ENDES due to software limitations.

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Implication

Supports altitude-specific BP references in Peru; hypothesis-generating for causal mechanisms and broader validation.

Abstract

Objetivos: Desarrollar curvas percentilares por edad para la presión arterial media (PAM), diastólica (PAD) y sistólica (PAS) en adultos peruanos de 20-59 años, estratificadas por altitud de residencia. Materiales y métodos: Se realizó un estudio transversal analítico con la Encuesta Demográfica y de Salud Familiar (ENDES) 2014-2024. Se incluyeron adultos de 20-59 años con dos mediciones válidas de presión arterial y sin diagnóstico previo de hipertensión. La altitud de residencia se clasificó en <2500, 2500-3499 y ≥3500 metros sobre el nivel del mar (m s.n.m.). Los percentiles (P5-P95) de la PAM, PAD y PAS se estimaron empleando modelos aditivos generalizados para localización, escala y forma (GAMLSS) con distribución Box-Cox Cole and Green (BCCG). Resultados: Se analizaron 227 093 adultos (edad media: 35,7 años; 56,2% mujeres). En todos los estratos de altitud, la PAM, PAD y PAS mostraron incrementos graduales entre los 20 y 50 años, aunque la magnitud del incremento se atenuó a mayor altitud. La PAD y la PAM mostraron relativa estabilidad después de los 50 años, mientras que la PAS continuó aumentando de forma más progresiva. A los 50 y 59 años, los valores de PAS fueron sistemáticamente más bajos en altitudes ≥3500 que en <2500 m s.n.m. Conclusiones: La distribución de la presión arterial varía según la altitud de residencia, con incrementos por edad menos marcados en zonas de mayor altitud. Las curvas de referencia percentilares generadas pueden aportar a la interpretación contextualizada de la presión arterial en poblaciones de alta altitud y fortalecer la vigilancia epidemiológica.

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Cite This Study

Hernández-Vásquez et al. (2026) conducted a cross-sectional in Blood pressure distribution (n=227,093). Higher altitude of residence (≥2500 m.a.s.l.) vs. Lower altitude of residence (<2500 m.a.s.l.) was evaluated on Blood pressure (MAP, DBP, SBP) percentile curves by age and altitude. Higher altitude of residence was associated with less pronounced age-related increases in blood pressure, resulting in systematically lower systolic blood pressure at older ages compared with residents at lower altitudes.

synapsesocial.com/papers/6a23bc0571a5da9775e77725 https://doi.org/10.47487/apcyccv.v7i1.596.

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Blood pressure reference curves by age and residential altitude in Peruvian adults.

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Blood pressure reference curves by age and residential altitude in Peruvian adults.

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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