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Blood pressure-to-height ratio as a screening indicator of elevated blood pressure among children and adolescents in Chongqing, China

Journal of Human Hypertension volume 31, pages 438–443 (2017)Cite this article

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Abstract

We aimed to evaluate the performance of blood pressure-to-height ratio (BPHR) and establish their optimal thresholds for elevated blood pressure (BP) among children aged 6 to 17 years in Chongqing, China. Data were collected from 11 029 children and adolescents aged 6–17 years in 12 schools in Chongqing according to multistage stratified cluster sampling method. The gold standard for elevated BP was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ⩾95th percentile for gender, age and height. The diagnostic performance of systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) to screen for elevated BP was evaluated through receiver-operating characteristic curves (including the area under the curve (AUC) and its 95% confidence interval, sensitivity and specificity). The prevalence of elevated BP in children and adolescents in Chongqing was 10.36% by SBP and/or DBP ⩾95th percentile for gender, age and height. The optimal thresholds of SBPHR/DBPHR for identifying elevated BP were 0.86/0.58 for boys and 0.85/0.57 for girls among children aged 6 to 8 years, 0.81/0.53 for boys and 0.80/0.52 for girls among children aged 9 to 11 years and 0.71/0.45 for boys and 0.72/0.47 for girls among adolescents aged 12–17 years, respectively. Across gender and the specified age groups, AUC ranged from 0.82 to 0.88, sensitivity were above 0.94 and the specificities were over 0.7. The positive predictive values ranged from 0.30 to 0.38 and the negative predictive values were ⩾0.99. BPHR, with uniform values across broad age groups (6–8, 9–11 and 12–17 years) for boys and for girls is a simple indicator to screen elevated BP in children and adolescents in Chongqing.

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Acknowledgements

We are grateful to the Institute of Child and Adolescent Health, School of Public Health, Peking University for giving us chance to participate in the study. We are also grateful to the school leaders, teachers and students of 12 schools who actively cooperated with the investigations. We are particularly grateful to Professor Rahul Malhotra (from Health Services and Systems Research Head of Research, Center for Ageing Research and Education, Duke-NUS Medical School) for revising the manuscript. This study was supported by the Research Special Fund for Public Welfare Industry of Health (No. 201202010). The study was approved by Biomedical Ethics Committee of Peking University and Medical Research Ethics Committee of Chongqing Medical University. All subjects gave informed consent.

Author contributions

HW conceived and designed the study. HW, LYW, QL, XTC and JJJ participated in the field studies and data collection. LYW and HW analyzed the data and drafted the manuscript. QL and RM revised the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China

    L Y Wang, Q Liu, X T Cheng, J J Jiang & H Wang

  2. Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China

    L Y Wang, Q Liu, X T Cheng, J J Jiang & H Wang

  3. School of Public Health and Management, Chongqing Medical University,, Chongqing, China

    L Y Wang, Q Liu, X T Cheng, J J Jiang & H Wang

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  1. L Y Wang
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  2. Q Liu
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  3. X T Cheng
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  5. H Wang
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Correspondence to H Wang.

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Wang, L., Liu, Q., Cheng, X. et al. Blood pressure-to-height ratio as a screening indicator of elevated blood pressure among children and adolescents in Chongqing, China. J Hum Hypertens 31, 438–443 (2017). https://doi.org/10.1038/jhh.2016.89

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