Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis

Abstract

The aim of this study was to assess the performance of the blood pressure-to-height ratio (BPHR) for screening elevated blood pressure (BP) in children and adolescents using a meta-analysis of eligible published studies. We retrieved studies that investigated the performance of the BPHR for identifying elevated BP from Pubmed and other databases. We performed meta-analyses by subgroups of sex, age and ethnicity using a fixed or random effect model based on whether there was between-study heterogeneity. A total of 13 publications including 262 830 children and adolescents aged 6–18 years on BPHR and a total of three publications including 95 343 children on the modified BPHR were included in this meta-analysis. The summary results suggested that BPHR performed well to identify pre-high BP and high BP for children aged 6–11 years and adolescents aged 12–18 years. The performance of BPHR was perfect for identifying severe high BP in adolescents aged 12–18 years. However, the modified BPHR did not improve accuracy for screening high BP in children aged 6–12 years. In summary, BPHR performed well for identifying elevated BP in children and adolescents, independently of sex, age and ethnicity group. In addition, the modified BPHR performed similarly with BPHR for screening high BP in childhood.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Ingelfinger JR . Clinical practice. The child or adolescent with elevated blood pressure. N Engl J Med 2014; 370: 2316–2325.

    Article  Google Scholar 

  2. de Moraes AC, Lacerda MB, Moreno LA, Horta BL, Carvalho HB . Prevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression. Medicine (Baltimore) 2014; 93: e232.

    Article  Google Scholar 

  3. Kollias A, Dafni M, Poulidakis E, Ntineri A, Stergiou GS . Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis. J Hypertens 2014; 32: 2315–2331.

    Article  CAS  Google Scholar 

  4. Chen X, Wang Y . Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008; 117: 3171–3180.

    Article  Google Scholar 

  5. Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC . Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010; 362: 485–493.

    Article  CAS  Google Scholar 

  6. Sundstrom J, Neovius M, Tynelius P, Rasmussen F . Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011; 342: d643.

    Article  Google Scholar 

  7. Gray L, Lee IM, Sesso HD, Batty GD . Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality: HAHS (Harvard Alumni Health Study). J Am Coll Cardiol 2011; 58: 2396–2403.

    Article  Google Scholar 

  8. National High Blood Pressure Education Program Working Group on High Blood Pressure in C, Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.

    Article  Google Scholar 

  9. Lu Q, Ma CM, Yin FZ, Liu BW, Lou DH, Liu XL . How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens 2011; 25: 159–163.

    Article  CAS  Google Scholar 

  10. Ejike CE . Blood pressure to height ratios as simple, sensitive and specific diagnostic tools for adolescent (pre)hypertension in Nigeria. Ital J Pediatr 2011; 37: 30.

    Article  Google Scholar 

  11. Rabbia F, Rabbone I, Totaro S, Testa E, Covella M, Berra E et al. Evaluation of blood pressure/height ratio as an index to simplify diagnostic criteria of hypertension in Caucasian adolescents. J Hum Hypertens 2011; 25: 623–624.

    Article  CAS  Google Scholar 

  12. Galescu O, George M, Basetty S, Predescu I, Mongia A, Ten S et al. Blood pressure over height ratios: simple and accurate method of detecting elevated blood pressure in children. Int J Pediatr 2012; 2012: 253497.

    Article  Google Scholar 

  13. Ejike CE, Yin FZ . Blood pressure-to-height ratio simplifies the diagnosis of hypertension in Nigerian children. J Trop Pediatr 2013; 59: 160–161.

    Article  Google Scholar 

  14. Lu Q, Ma C, Yin F, Wang R, Lou D, Liu X . Blood pressure-to-height ratio as a screening measure for identifying children with hypertension. Eur J Pediatr 2013; 172: 99–105.

    Article  Google Scholar 

  15. Totaro SRF, Rabbone I, Covella M, Berra E, Fulcheri C, Monaco SD et al. Comparison among different screening tests for diagnosis of adolescent hypertension. ISRN Hypertension 2013; 2013: 107915.

    Article  Google Scholar 

  16. Kelishadi R, Heshmat R, Ardalan G, Qorbani M, Taslimi M, Poursafa P et al. First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study. J Pediatr (Rio J) 2014; 90: 85–91.

    Article  Google Scholar 

  17. Outdili Z, Marti-Soler H, Simonetti GD, Bovet P, Paccaud F, Burnier M et al. Performance of blood pressure-to-height ratio at a single screening visit for the identification of hypertension in children. J Hypertens 2014; 32: 1068–1074.

    Article  CAS  Google Scholar 

  18. Xi B, Zhang M, Zhang T, Li S, Steffen LM . Simplification of childhood hypertension definition using blood pressure to height ratio among US youths aged 8-17years, NHANES 1999-2012. Int J Cardiol 2014; 180C: 210–213.

    Google Scholar 

  19. Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LM . Hypertension screening using blood pressure to height ratio. Pediatrics 2014; 134: e106–e111.

    Article  Google Scholar 

  20. Dong B, Wang Z, Wang HJ, Ma J . Blood pressure-to-height ratio for screening prehypertension and hypertension in Chinese children. J Hum Hypertens 2015; 29: 618–622.

    Article  CAS  Google Scholar 

  21. Kelishadi R, Bahreynian M, Heshmat R, Motlagh ME, Djalalinia S, Naji F et al. Accuracy of blood pressure-to-height ratio to define elevated blood pressure in Children and adolescents: the CASPIAN-IV Study. Pediatr Cardiol 2015 doi:10.1007/s00246-015-1287-1.

  22. Mourato FA, Nadruz W Jr, Moser LR, de Lima Filho JL, Mattos SS . A modified blood pressure to height ratio improves accuracy for hypertension in childhood. Am J Hypertens 2015; 28: 409–413.

    Article  Google Scholar 

  23. Ma C, Lu Q, Yin F . The performance of modified blood pressure-to-height ratio as a screening measure for identifying children with hypertension. Clin Exp Hypertens 2016; 38: 155–159.

    Article  CAS  Google Scholar 

  24. Dong B, Wang Z, Wang HJ, Ma J . Improving Hypertension Screening in Childhood Using Modified Blood Pressure to Height Ratio. J Clin Hypertens (Greenwich) 2015 doi:10.1111/jch.12712.

  25. Lijmer JG, Bossuyt PM, Heisterkamp SH . Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat Med 2002; 21: 1525–1537.

    Article  Google Scholar 

  26. Dinnes J, Deeks J, Kirby J, Roderick P . A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy. Health Technol Assess 2005; 9: 1–113.

    Article  CAS  Google Scholar 

  27. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH . Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005; 58: 982–990.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by Young Scholars Program of Shandong University (2015WLJH51), the Research Fund for the Doctoral Program of Higher Education of China (20120131120004), National Natural Science Foundation of China (81302496) and Shandong Natural Science Foundation (ZR2012HQ033).

Author contributions

XY, QL, PB, CM and BX contributed to the manuscript including the conception and design of the study, analysis and interpretation of the data, drafting and critically revising the manuscript, and approval for publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B Xi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yin, X., Liu, Q., Bovet, P. et al. Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis. J Hum Hypertens 30, 697–702 (2016). https://doi.org/10.1038/jhh.2016.12

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.12

This article is cited by

Search

Quick links