To create our simplified blood pressure charts, we calculated the lowest blood pressure threshold value for each gender and 5-cm height group. Current Fourth Report tables contain 476 blood pressure threshold values for each gender, age, and height percentile generated from regression model equations provided in the appendix of the Fourth Report. We used the 2004 Fourth Report as the source for all threshold values in our simplified charts. Because height accounts for substantially more BP variability than age in children, we will reference BP thresholds to absolute height in a gender-specific chart format.Īlthough the study was approved by the local IRB (HSC-MS-12-0432), no subjects were required for the analysis so no informed consent was necessary. We create blood pressure charts based on BP thresholds derived from the Fourth Report which can be used to identify any BP percentile, including abnormally high or low pressures. The purpose of this paper is to create a simple and practical BP screening tool to use alongside existing growth charts by the Center Of Disease Control (CDC) and World Health Organization (WHO). Additionally, none of these published BP charts depict lower BP thresholds below the 50th percentile. Height (stature), rather than age, is a better primary reference metric because it is a more precise measure of body size and maturation which are the primary determinants of the natural rise of BP throughout childhood. Although several simplified BP charts have been reported in literature, the available US based charts are based on outdated reference values and use age as the primary body size reference. The implementation of a simple graphical representation of a child’s BP percentile similar to growth charts currently used for height, weight, BMI, and head circumference would improve and streamline pediatric primary care. The American Academy of Pediatrics has endorsed NHLBI guidelines that recommend all children over 3 years of age have BP measured at least annually for early recognition of BP abnormalities such as hypertension or syncope, although studies have shown this screening is rarely done in children.
Often these tables are used incorrectly or not at all. Instead complex BP tables consisting of 476 threshold blood pressure values are used to lookup the BP percentile for a child. While BP tracks with growth in children, similar to anthropometric measurements such as height and weight, it is not currently charted in the same way using growth charts.
While adult blood pressure thresholds are static, 140/90 mmHg for hypertension and 90/60 mmHg for hypotension, each child has his/her own BP thresholds based on gender, age, and height percentile. Recognizing blood pressure (BP) abnormalities in children is more cumbersome than in adults and contributes to underdiagnoses in pediatrics.