title: Simplification of childhood hypertension definition using blood pressure to height ratio among US youths aged 8-17years, NHANES 1999-2012.
abstract: BACKGROUND
  The fourth report on the diagnosis, evaluation, and treatment of high blood pressure (BP) established high BP diagnostic criteria using age-, sex-, and height-specific BP percentiles. However, these BP criteria are quite difficult for use by professionals in the clinic or children and their parents. We aimed to simplify the hypertension diagnostic criteria using BP to height ratio (BP/height) in US children and adolescents aged 8-17years.
  
  
  METHODS
  Data were obtained from a national representative sample of 14,624 US children and adolescents aged 8-17years enrolled in the continuous National Health and Nutrition Examination Survey 1999-2012. SBP to height ratio (SBPHR) was calculated as SBP (mmHg)/height (cm) and DBP to height ratio (DBPHR) was calculated as DBP (mmHg)/height (cm). The BP diagnostic criteria recommended by the fourth report were used as the "gold standard". Receive operator characteristic curve analysis was used to choose the optimal thresholds of SBPHR and DBPHR.
  
  
  RESULTS
  The optimal thresholds for identifying pre-hypertension and hypertension among children aged 8-12years and adolescents aged 13-17years were determined. The negative predictive value (NPV) for identifying hypertension was nearly 100% for both children and adolescents, although the positive predictive value (PPV) ranged from 19% to 35%. The NPV for identifying pre-hypertension ranged from 95% to 99% for children and adolescents, and the PPV ranged from 11% to 52%.
  
  
  CONCLUSIONS
  The optimal thresholds of SBPHR and DBPHR are simple and accurate for screening elevated BP, although PPV is relatively low because of the low prevalence of childhood hypertension.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China. Electronic address: xibo2010@sdu.edu.cn.
authors.forename: Bo
authors.initials: B
authors.lastname: Xi
authors.affiliation: Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China.
authors.forename: Meixian
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China.
authors.forename: Shuangshuang
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA. Electronic address: steffen@umn.edu.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Steffen
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D001827:Body Height / Q000502:physiology*; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D009749:Nutrition Surveys; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Blood pressure to height ratio; Children; Diagnostic criteria; Hypertension