title: Impacts of measurement protocols on blood pressure tracking from childhood into adulthood: a metaregression analysis.
abstract: The best approach for blood pressure (BP) measurement in children remains controversial, specifically regarding the choice of Korotkoff phase 4 versus Korotkoff phase 5 for diastolic BP (DBP) and the use of automated devices. To examine the impacts of different BP measurement protocols on BP tracking from childhood into adulthood, we conducted a meta-analysis of 50 related studies published between 1970 and 2006 identified based on a systematic search of PubMed. These studies provided 617 data points (tracking correlation coefficient, our outcome variable) for systolic BP and 547 data points for DBP for our meta-analysis. The explanatory variables included the use of Korotkoff phase 4/Korotkoff phase 5, BP device, and number of BP measurements per visit. Analyses were adjusted for potential confounders, including sex, baseline age, follow-up length, publication year, and study country. Tracking correlation coefficients for DBP measured using Korotkoff phase 4 was higher than that of Korotkoff phase 5 by 0.035 but not significant. DBP tracking assessed by automated device was higher than that of Korotkoff phase 5 by 0.152 (P=0.024) and higher than the mercury manometer by 0.223 (P=0.005). BP tracking was slightly higher with multiple BP measurements per visit, but measurements of >or=3 times did not improve the tracking further compared with 2 measurements. Although policy-making bodies currently recommend the use of Korotkoff phase 5 to assess DBP in children, our metaregression analysis did not support the recommendation. In general, Korotkoff phase 4 seems to be different from Korotkoff phase 5, and automated device is a promising approach for BP assessment in childhood.
authors.affiliation: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Hopkins University, Baltimore, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Chen
authors.forename: Youfa
authors.initials: Y
authors.lastname: Wang
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Jie
authors.initials: J
authors.lastname: Mi
mesh_terms: D000293:Adolescent; D000375:Aging / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods; D015924:Blood Pressure Monitors; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology