Use of Multiple Visits to Increase Blood Pressure Tracking Correlations in Childhood

Previous studies of childhood blood pressure have shown tracking correlations, which estimate the magnitude of association between initial and subsequent measurements, to be lower than corresponding adult values. Inasmuch as this disparity could arise from failing to account for a larger week-to-week variability in children, blood pressure was measured for 4 successive years, on four weekly visits in each year, and with three measurements at each visit, using a random-zero sphygmomanometer, in a cohort of 333 schoolchildren aged 8 through 15 at entry. Ninety percent of subjects had measurements in 1 or more years of follow-up. For all follow-up periods (1, 2, and 3 years from baseline), the Pearson correlation coefficient (r) for both systolic and diastolic blood pressure rose substantially with the number of weekly visits used to calculate each subject's yearly blood pressure (P less than .0001). For systolic pressure, the 3-year r values for 1, 2, 3, and 4 visits were .45, .55, .64, and .69, respectively. For diastolic pressure (Korotkoff phase 4), the corresponding values were .28, .41, .47, and .54. These higher multiple-visit estimates of tracking approximate published adult values and raise the possibility that prediction of adult blood pressure from childhood measurements may be improved by averaging readings from multiple weekly visits.