TY - JOUR
T1 - Establishing International Blood Pressure References among Nonoverweight Children and Adolescents Aged 6 to 17 Years
AU - Xi, Bo
AU - Zong, Xin'Nan
AU - Kelishadi, Roya
AU - Hong, Young Mi
AU - Khadilkar, Anuradha
AU - Steffen, Lyn M.
AU - Nawarycz, Tadeusz
AU - Krzywińska-Wiewiorowska, Małgorzata
AU - Aounallah-Skhiri, Hajer
AU - Bovet, Pascal
AU - Chiolero, Arnaud
AU - Pan, Haiyan
AU - Litwin, Mieczysław
AU - Poh, Bee Koon
AU - Sung, Rita Y.T.
AU - So, Hung Kwan
AU - Schwandt, Peter
AU - Haas, Gerda Maria
AU - Neuhauser, Hannelore K.
AU - Marinov, Lachezar
AU - Galcheva, Sonya V.
AU - Motlagh, Mohammad Esmaeil
AU - Kim, Hae Soon
AU - Khadilkar, Vaman
AU - Krzyzaniak, Alicja
AU - Romdhane, Habiba Ben
AU - Heshmat, Ramin
AU - Chiplonkar, Shashi
AU - Stawińska-Witoszyńska, Barbara
AU - El Ati, Jalila
AU - Qorbani, Mostafa
AU - Kajale, Neha
AU - Traissac, Pierre
AU - Ostrowska-Nawarycz, Lidia
AU - Ardalan, Gelayol
AU - Parthasarathy, Lavanya
AU - Zhao, Min
AU - Zhang, Tao
N1 - Funding Information:
We thank Tim J Cole (UCL Institute of Child Health, London, UK) for helping to improve this manuscript. We also thank the US and China Centers for Disease Control and Prevention, and University of North Carolina for sharing their valuable data. This study was supported by Young Scholars Program of Shandong University (2015WLJH51), the National Institutes of Health (NIH; grants R01-HD30880, DK056350, R24-HD050924, and R01-HD38700), as part of a national school-based surveillance program funded by the Iran Ministry of Health. The sponsors had no role in the study design, survey process, data analysis, and manuscript preparation.
Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2016/1/26
Y1 - 2016/1/26
N2 - Background-Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). Methods and Results-Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. Conclusions-These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.
AB - Background-Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). Methods and Results-Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. Conclusions-These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.
KW - Adolescent
KW - Blood pressure
KW - Child
KW - Hypertension
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U2 - 10.1161/CIRCULATIONAHA.115.017936
DO - 10.1161/CIRCULATIONAHA.115.017936
M3 - Article
C2 - 26671979
AN - SCOPUS:84969382139
SN - 0009-7322
VL - 133
SP - 398
EP - 408
JO - Circulation
JF - Circulation
IS - 4
ER -