Key result
All 11 simplified methods performed well in screening high blood pressure (AUC 0.84-0.98), but 3 methods achieved a positive predictive value of ≈0.90 and may be most useful for screening.
Why the study?
Do simplified methods accurately identify elevated or high blood pressure in children and adolescents?
Cross-Sectional (n=58,899)
Yes
Do simplified methods accurately identify elevated or high blood pressure in children and adolescents?
Three simplified methods (sex- and age-specific BP references at 95th percentile of height, formula for BP references, and absolute height method) offer high accuracy and positive predictive value for screening elevated blood pressure in children.
May aid efficient pediatric BP screening; leaves open prospective validation before practice change.
The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84-0.98), high sensitivity (0.69-1.00), high specificity (0.87-1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child's absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.
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Ma et al. (2016) conducted a cross-sectional in Elevated or high blood pressure (n=58,899). 11 simplified methods for assessing elevated or high BP vs. Complex percentile tables was evaluated on Performance for screening elevated or high BP (AUC, sensitivity, specificity, PPV, NPV). All 11 simplified methods performed well in screening high blood pressure (AUC 0.84-0.98), but 3 methods achieved a positive predictive value of ≈0.90 and may be most useful for screening.
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