The identification of elevated blood pressure (BP) in children and adolescents relies on probabilistic criteria defined by age, sex and height percentiles, as recommended by guidelines. The use of height percentiles is regarded as complex and has been suggested to result in underdiagnosis of elevated BP. To address this, a simplified criteria has been proposed that uses age and sex (simplified 1) or only age (simplified 2) criteria to identify elevated BP. Although simplified criteria are increasingly being used in research, their clinical value remains to be determined. The extent to which these different criteria may affect the prevalence of elevated BP has never been assessed. This study aimed to determine the prevalence of elevated BP across different BP criteria (complex, simplified 1 and simplified 2) in a nationally representative population of young people.Design and Method:
Data were analyzed from the 2011–2013 Australian Health Survey among 3,047 children and adolescents, aged 5–17 years old (mean age 12[95CI; 12,13] years, males 52%). Two consecutive BPs were recorded by oscillometry, with elevated BP defined according to the simplified assessment criteria, which was in the pre-hypertension stage only.Results:
The prevalence of pre-hypertension was 20% using the complex criteria, but 27% and 29% using simplified 1 and simplified 2 criteria, respectively. Despite these discrepancies there were no clinically meaningful differences in the cardiovascular risk profile of subjects identified with pre-hypertension across the different criteria. However, there was a 7% to 8% difference in the prevalence of tall stature using the simplified criteria (table). The highest prevalence of tall stature (36%) was observed using simplified 2 criteria.Conclusions:
Using simplified criteria to identify elevated BP resulted in an increase in the prevalence of children and adolescents with pre-hypertension. The difference in tall stature between the different criteria suggests an overestimation of pre-hypertension with criteria which are not height-dependent.