Gillman M W, Cook N R, Rosner B, Evans D A, Keough M E, Taylor J O, Hennekens C H
Channing Laboratory, Brigham and Women's Hospital, Boston, MA.
Epidemiology. 1992 Jan;3(1):40-6. doi: 10.1097/00001648-199201000-00008.
Blood pressure measurement in childhood can be considered as a screening test for future blood pressure levels. Evaluating this test involves calculating sensitivities, specificities, and predictive values for a blood pressure measurement at an initial time for predicting underlying true blood pressure at a subsequent time. We demonstrate the use of childhood blood pressure tracking correlations that are corrected for within-person variability to calculate unbiased estimates of these test characteristics. In a cohort of 333 schoolchildren, we measured blood pressure on multiple visits in each of 4 successive years. Using these data for within-person variances and corrected tracking correlations, and U.S. population data for means and total variances, we tabulated positive predictive values, sensitivities, and specificities for the case of predicting a 9-year-old male's true systolic blood pressure 3 years later. For example, if a 9-year-old's average blood pressure from 4 visits is 115 mmHg, the probability of his true blood pressure being greater than 116 mmHg (90th percentile) at age 12 is 0.50. With longer follow-up, the use of predictive values, sensitivities, and specificities that incorporate corrected correlations should allow determination of the accuracy of predicting adult blood pressure from childhood values, and therefore the usefulness of screening children for those at high risk of developing hypertension.
儿童期血压测量可被视为未来血压水平的一项筛查测试。评估此项测试涉及计算初始时刻血压测量值对于预测后续时刻潜在真实血压的敏感度、特异度和预测值。我们展示了利用针对个体内部变异性进行校正的儿童期血压追踪相关性来计算这些测试特征的无偏估计值。在一个由333名学童组成的队列中，我们在连续4年的每年多次访视中测量血压。利用这些数据得出个体内部方差和校正后的追踪相关性，并结合美国人口数据中的均值和总方差，我们列出了预测一名9岁男性3年后真实收缩压情况下的阳性预测值、敏感度和特异度。例如，如果一名9岁儿童4次访视的平均血压为115 mmHg，那么他12岁时真实血压高于116 mmHg（第90百分位数）的概率为0.50。随着随访时间延长，使用纳入校正相关性的预测值、敏感度和特异度应能够确定根据儿童期血压值预测成人血压的准确性，从而确定筛查儿童中高血压高危人群的效用。
