A simplified pediatric blood pressure table may simplify screening for potentially abnormal blood pressures in children and adolescents, according to the results of a study reported in the June issue of Pediatrics.
The simplified table is available in the original article available on thePediatrics Web site.
"Pediatric hypertension and prehypertension are significantly underdiagnosed," write David C. Kaelber, MD, PhD, MPH, from Case Western Reserve University in Cleveland, Ohio, and Frieda Pickett, RDH, MS, from Texas A&M Health Science Center, Dallas, Texas. "Part of this underdiagnosis may be related to the complexity of the current pediatric blood pressure tables and their requirement for knowledge of the patient's height percentile."
This study aimed to design a screening tool to identify children and adolescents with possible hypertension or prehypertension, using data from existing tables from the Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. By analyzing data from hundreds of normal and abnormal blood pressure values based on age, sex, and height percentile, the investigators developed a much simplified table based only on age and sex.
The number of values in the simplified table was reduced from 476 to 64. For each year of life (from ages 3 to ≥ 18 years), the table has only 1 threshold value of abnormal systolic and diastolic blood pressure, by sex, which facilitates identification of abnormal blood pressure values in almost any clinical or screening setting.
"This screening tool can quickly and easily identify children and adolescents whose blood pressure readings merit further evaluation by a physician and rule out abnormal blood pressure in children and adolescents," the study authors write. "This approach is ideal when blood pressure is measured outside a physician's office or even at intake in a pediatrician's office, when the height percentile (which is required for the use of current tables) may not be easily obtainable."
Limitations of this screening tool include possible false-positive identification of abnormal blood pressure values for taller children.
"Although a long-term solution for the identification of pediatric hypertension and prehypertension may involve electronic medical records and other electronic tools, this proposed simplified blood pressure table should help in the interim and in circumstances where electronic tools may not be available," the study authors conclude. "Because abnormally elevated blood pressure can result in significant decreases in systemic health over time, it is imperative to identify prehypertension and hypertension in the pediatric population and to evaluate further those children and adolescents who have values at or above those presented in this simplified table. This simplified abnormal blood pressure screening table can be used as a very effective screening tool to rule out abnormal blood pressures."
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