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Use of static cutoffs of hypertension to determine high cIMT in children and adolescents: an International Collaboration Study

Yang, L, Whincup, PH, Lopez-Bermejo, A, Caserta, CA, Medeiros, CCM, Kollias, A, Pacifico, L, Reinehr, T, Litwin, M, Owen, CG, Bassols, J, Romeo, EL, Ramos, TDA, Stergiou, GS, Zhao, M, Yang, L, Xargay-Torrent, S, Amante, A, Gusmao, TME, Grammatikos, E, Wang, M, Prats-Puig, A, de Carvalho, DF, Carreras-Badosa, G, de Oliveira Simoes, M, Mas-Pares, B, Shui, W, Deanfield, JE, Magnussen, CG ORCID: 0000-0002-6238-5730 and Xi, B 2020 , 'Use of static cutoffs of hypertension to determine high cIMT in children and adolescents: an International Collaboration Study' , Canadian Journal of Cardiology , pp. 1-7 , doi: 10.1016/j.cjca.2020.02.093.

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Abstract

Background: Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents. Methods: Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs. Results: Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05). Conclusion: Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.

Item Type: Article
Authors/Creators:Yang, L and Whincup, PH and Lopez-Bermejo, A and Caserta, CA and Medeiros, CCM and Kollias, A and Pacifico, L and Reinehr, T and Litwin, M and Owen, CG and Bassols, J and Romeo, EL and Ramos, TDA and Stergiou, GS and Zhao, M and Yang, L and Xargay-Torrent, S and Amante, A and Gusmao, TME and Grammatikos, E and Wang, M and Prats-Puig, A and de Carvalho, DF and Carreras-Badosa, G and de Oliveira Simoes, M and Mas-Pares, B and Shui, W and Deanfield, JE and Magnussen, CG and Xi, B
Journal or Publication Title: Canadian Journal of Cardiology
Publisher: Pulsus Group Inc
ISSN: 0828-282X
DOI / ID Number: 10.1016/j.cjca.2020.02.093
Copyright Information:

Copyright 2020 Canadian Cardiovascular Society. Published by Elsevier Inc

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