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Canadian Journal of Cardiology

Use of Static Cutoffs of Hypertension to Determine High cIMT in Children and Adolescents: An International Collaboration Study

Published:March 04, 2020DOI:https://doi.org/10.1016/j.cjca.2020.02.093

      Abstract

      Background

      Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents.

      Methods

      Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs.

      Results

      Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05).

      Conclusion

      Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.

      Résumé

      Contexte

      En pédiatrie, l’hypertension est généralement définie comme étant une pression artérielle égale ou supérieure au seuil du 95e centile établi selon l’âge, le sexe et la taille de l’enfant. Étant donné le nombre de strates, il existe des centaines de seuils définissant la pression artérielle élevée et l’hypertension, ce qui rend fastidieuse l’utilisation de cette méthode dans la pratique clinique. Nous avons tenté d’évaluer l’utilité de seuils statiques de l’hypertension infantile (120/80 mmHg chez l’enfant et 130/80 mmHg chez l’adolescent) pour déterminer la présence d’une épaisseur de l’intima-média carotidienne (EIMc) marquée chez les enfants et les adolescents.

      Méthodologie

      Nous avons examiné les données de 6 études transversales menées auprès de sujets représentatifs de la population au Brésil, en Chine, en Grèce, en Italie, en Espagne et au Royaume-Uni. Au total, 4 280 enfants et adolescents âgés de 6 à 17 ans ont été inclus dans l’étude. Une EIMc marquée a été définie comme étant une EIMc égale ou supérieure au seuil du 90e centile établi selon l’âge, le sexe et la cohorte du sujet.

      Résultats

      Par rapport à la pression artérielle normale, l’hypertension définie au moyen des seuils fondés sur les centiles tirés des lignes directrices de 2017 de l’American Academy of Pediatrics ou des seuils statiques a été associée à une probabilité élevée comparable d’EIMc marquée (seuils fondés sur les centiles : rapport de cotes [RC] de 1,46; intervalle de confiance [IC] à 95 % : de 1,15 à 1,86; seuils statiques : RC de 1,65; IC à 95 % : de 1,25 à 2,17), après correction pour tenir compte du sexe, de l’âge, de la race/origine ethnique, de l’indice de masse corporelle, du taux de cholestérol des lipoprotéines de haute densité, du taux de triglycérides et de la glycémie à jeun. L’utilité équivalente des deux définitions pour déterminer la présence d’une EIMc marquée a aussi été confirmée au moyen de l’analyse de l’aire sous la courbe caractéristique de la performance d’un test et de l’analyse de l’amélioration nette de la reclassification (p pour la différence > 0,05).

      Conclusion

      Les seuils statiques (120/80 mmHg pour les enfants, 130/80 mmHg pour les adolescents) et les seuils fondés sur les centiles ont donné des résultats comparables en matière de détermination de la présence d’une EIMc marquée, ce qui montre qu’il est possible d’utiliser des seuils statiques pour évaluer l’hypertension dans la pratique clinique en pédiatrie.
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      Linked Article

      • The Problem of Diagnosing Pediatric Hypertension: Is Using Static Blood Pressure Cutoffs Instead of Blood Pressure Tables a Solution?
        Canadian Journal of CardiologyVol. 36Issue 9
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          The prevalence of hypertension in children ranges from 2% to 5%; however, children frequently go undiagnosed.1-4 This is largely due to omission of blood pressure (BP) measurement or, when BP is measured, the failure to correctly recognise hypertensive values. Up to 70% of pediatric physicians measure BP only when risk factors for hypertension are present.5 In addition, when BP is measured and meets hypertensive criteria, up to 74% of patients are not diagnosed with hypertension.3 This may be because pediatric physicians often do not compare measured BP with the diagnostic BP tables.
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