American Journal of Epidemiology Vol. 126, No. 6: 1115-1125
Copyright © 1987 by The Johns Hopkins University School of Hygiene and Public Health
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REPRODUCIBILITY AND PREDICTIVE VALUES OF ROUTINE BLOOD PRESSURE MEASUREMENTS IN CHILDREN
COMPARISON WITH ADULT VALUES AND IMPLICATIONS FOR SCREENING CHILDREN FOR ELEVATED BLOOD PRESSURE
1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Departments of Preventive Medicine and Clinical Epidemiology and Medicine, Harvard Medical School Boston, MA
2Department of Epidemiology The Johns Hopkins University School of Hygiene and Public Health Baltimore, MD
3East Boston Neighborhood Health Center East Boston, MA
Reprint requests to Dr. Bernard Rosner, Channing Laboratory, 180 Longwood Avenue, Boston, MA 02115
Rosner, B. (Charming Laboratory, Boston, MA 02115), N. R. Cook, D. A. Evans, M. E. Keough, J. O. Taylor, B. F. Polk, and C. H. Hennekens. Reproducibility and predictive values of routine blood pressure measurements in children: comparison with adult values and implications for screening children for elevated blood pressure. Am J Epitemiol 1987; 126:1115–25.
A study of the variability of blood pressure was conducted among a total of 780 Massachusetts children, 335 children In East Boston and 445 children In Brookline, ages 8–18 years. All children had their blood pressure measured with a standard mercury sphygmomanometer In a school setting on four visIts one week apart with three measurements per visit. In East Boston, repeat measurements were made for the same children for four consecutive years. A nested random effects model was used to estimate between- and within-visit variance components. For children aged 8–12 years, these were, respectively, 33.1, 12.0 In boys and 31.2, 11.1 In girls for systolic blood pressure and 57.7, 21.3 In boys and 56.6, 22.6 In girls for systolic muffling blood pressure (Korotkotf phase 4). For children aged 13–18 years of age, they were, respectively, 41.1, 11.8 In boys and 35.2, 12.2 In girls for blood pressure and 40.6, 15.5 In boys and 36.1,11.4 In girls for diastolic blood pressure (Korotkofl phase 5). Within-person variabIlity for systolic pressure was comparable to previously publIshed data for 434 whIte adults ages 30–49 years not on antlhypertenslve medications; however, within- person variability for diastolic pressure was considerably higher In the children, accounting for over 75% of total variability among 8–12-year-old children, compared with 27% for adults. No meaningful effects of age, sex, or blood pressure level on variability of systolic pressure were found. However, age and level of blood pressure each had a large and Independent Inverse association with variability of diastolic pressure; variance components for younger children (ages 8–12 years) and children with low diastolic pressure (<60 mmHg) were approxi mately twice as large as for older children (ages 13–18 years) and children with diastolic pressure 
60 mmHg, respectively. Finally, predictive value estimates of blood pressure are provided for particular age-sex groups to enable one to efficiently Identify children whose true mean level of blood pressure exceeds the 90th percentile for their age-sex group with minimum misclassification. Because of the substantial variability of diastolic pressure in young children, resulting in relatively low predIctive value estimates, systolic pressure (either alone or in combination with diastolic pressure) may be more useful as the primary tool for screening children under age 13 years for high blood pressure.
blometry; blood pressure; hypertension; pediatrics
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