Suitability of blood-pressure-to-height ratio as the criterion for high blood pressure in children in an environmental study

Abstract

Background: Blood-pressure-to-height ratio is considered a simple, accurate, inexpensive and non-age-dependent index for screening high blood pressure in a clinical setting, but its suitability in epidemiological surveys was not taken into consideration. The aim of this study was to test the suitability of blood-pressure-to-height ratio against blood pressure for age percentiles for the identification of high blood pressure in an environmental study.

Methods: The sample consisted of 2195 children, aged 3 to 15 years, whose blood pressure was measured as part of an environmental study in Belgrade, Serbia. High blood pressure was estimated using percentiles (gold standard) and blood-pressure-to-height ratios for systolic and diastolic pressures separately (proposed criterion). The optimal cut-offs of the blood-pressure-to-height ratio (BPHR) were selected based on Youden’s index (sensitivity + specificity − 1) calculated from the receiver operator characteristic curve analysis.

Results: The proposed criterion identified five times more cases of high blood pressure in the investigated children of all age groups in comparison to the gold standard. The optimal cut-off values were selected based on the sensitivity and specificity values by age groups and gender.

Conclusion: Blood-pressure-to-height ratio can be a reliable criterion for the estimation of high blood pressure in epidemiological studies. This is the first study on the applicability of blood-pressure-to-height ratio in Serbian children, but it may not be easily generalized to other populations due to small sample size across the examined age groups and potential diversities in risk factors for high blood pressure. Applied in epidemiological studies, BPHR would help researchers estimate the role of certain environmental factors on blood pressure in children.

Keywords:

• Blood pressure, measurement
• blood pressure percentiles
• blood-pressure-to-height ratio
• epidemiological study
• validity

Transparency

Declaration of funding

The work has been supported by the Ministry of Science and Technological Development of the Republic of Serbia, project no. OI1621039.

Declaration of financial/other relationships

K.P. and B.J. have disclosed that they have received grants from the Ministry of Science and Technological Development of the Republic of Serbia to conduct this study.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors are grateful to Prof. Goran Belojević, Prof. Vesna Stojanov and Ass. Jelena Ilić Živojinović who participated in field research from 2006 to 2010.