Practice Evaluation Of Four Simplified Blood Pressure Standards For Screening Elevated Blood Pressure And Hypertension In Children And Adolescents

Objective: To establish four simplified blood pressure standards and to evaluate their utility for screening elevated blood pressure and hypertension in children and adolescents.Methods: Based on the standard of screening threshold value of elevated blood pressure among children and adolescents aged 718 published[1] by the National Health Commission in 2018,four simplified blood pressure methods(height-specific method,formula method,method based on ≥P50 height percentile,method based on ≥P95 height percentile)were used to develop four simplified standards.The gold standard and four simplified standards were used to determine elevated blood pressure and hypertension of 6517 children and adolescents in the epidemiological survey of simple obesity in Maoming.The AUC,sensitivity,specificity,positive predictive value,negative predictive value and kappa value of the four simplified standards were calculated,and the screening effect of them was evaluated and compared.The data of 2446 children and adolescents in the 2011~2015 China Health and Nutrition Survey(CHNS)were used to further evaluate the applicability of the four simplified standards in different populations.Results:(1)Basic information of research object There are 6517 children and adolescents in “Maoming population”,3657 of them are boys,accounting for 56.1% and 2860 of them are girls,accounting for 43.9%.Based on the "industry standard",the detection rate of elevated blood pressure in “Maoming population” is 6.8%(male: 8.4%;female: 4.6%),and the detection rate of hypertension is 3.6%(male: 3.6%;female: 3.6%).There are 2446 children and adolescents in "CHNS population",including 1252 boys(51.2%)and 1194 girls(48.8%).Based on the "industry standard",the detection rate of hypertension was 9.9%(male: 12.1%;female: 7.5%),and the detection rate of hypertension was 10.5%(male: 11.6%;female: 9.4%).(2)Practical evaluation of the effect of four simplified standards in screening elevated blood pressure and hypertension In "Maoming population",four simplified screening criteria are used to screen elevated blood pressure.The screening effect of height-specific method,method based on ≥P50 height percentile and formula method is better than that of method based on ≥P95 height percentile.The AUC of height-specific method and method based on ≥P50 height percentile is better than that of method based on ≥P95 height percentile.The AUC of both methods is greater than 0.900,0.903 and 0.904 respectively,and the kappa value of both methods is greater than 0.800,0.833,0.821 respectively.The sensitivity,specificity,positive predictive value and negative predictive value of height-specific method are all higher,81.41%,99.16%,87.56% and 98.66% respectively.The sensitivity,specificity,positive predictive value and negative predictive value of method based on ≥P50 height percentile are also higher,81.86%,98.93%,84.74% and 98.69% respectively.Four simplified screening criteria were used to screen hypertension in "Maoming population".The results showed that AUC of height-specific method,method based on ≥P50 height percentile and formula method were greater than 0.900(0.918,0.927,0.940)and AUC based on method based on ≥P95 height percentile(0.715).the AUC of the formula method Although larger,its positive predictive value is the lowest of the four simplified standards(77.57%).(3)Practical validation of four simplified standards for screening elevated blood pressure and hypertension Considering that "Maoming population" includes only the population of Maoming City and lacks representativeness,and "CHNS population" includes children and adolescents in nine provinces of the country,using "CHNS data" to verify the screening effect of the four simplified standards can be effective Improve the persuasiveness of the conclusion of this study.Screening for elevated blood pressure in "CHNS population",It was found that the AUC of height-specific method(0.887),(0.842)and formula method(0.778)were higher than that of method based on ≥P95 height percentile(0.778),Kappa value is also the larger of the three,respectively 0.757,0.704,0.607.Among these three simplified methods,height-specific method and are better.The effect of four simplified standards on hypertension screening was verified in the "CHNS population".The results showed that the AUC of height-specific method,method based on ≥P50 height percentile and formula method were all greater than 0.900,which were 0.934,0.936 and 0.919 respectively.The kappa value is also the largest of the three,which are 0.873,0.866 and 0.809 respectively.The sensitivity,specificity,positive predictive value and negative predictive value of height-specific method and method based on ≥P50 height percentile were higher,while the sensitivity,specificity and negative predictive value of formula method were higher,and the positive predictive value was lower,the screening effect is not as good as the first simplified screening criteria.Conclusion:(1)The results of elevated blood pressure and high blood pressure screening in "Maoming population" and "CHNS population" by height-specific method,formula method and method based on ≥P50 height percentile are totally good.Among them,height-specific method and method based on ≥P50 height percentile have the best screening effect.There are 88 diagnostic boundary values based on height percentile method of ≥P50,and only 28 diagnostic boundary values based on the simplified standard of height-specific method.It can be seen that the simplified standard of height-specific method is more practical among the four simplified standards.Using this simplified standard can make early screening of elevated blood pressure and hypertension screening in children and adolescents efficient and convenient.(2)Although the specificity and positive predictive value of method based on ≥P95 height percentile in screening hypertension of children and adolescents are 100%,its AUC,kappa value,sensitivity and negative predictive value are all low,which shows that the consistency between the simplified standard and the complex standard is poor,and the screening effect is not ideal.