Di Bonito P, Valerio G, Pacifico L, Chiesa C, Invitti C, Morandi A, Maffeis C, Licenziati M R, Manco M, Miraglia Del Giudice E, Baroni M G, Loche S, Tornese G, Tomat M, de Simone G
Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy.
Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
Nutr Metab Cardiovasc Dis. 2017 Sep;27(9):830-835. doi: 10.1016/j.numecd.2017.06.013. Epub 2017 Jun 30.
Hypertension (HTH) is a frequent complication in pediatric obesity. To simplify the screening of HTH in overweight/obese (Ow/Ob) youth, we compared the performance of a new index (High Blood Pressure index, HBPi) with respect to the standard criteria of the IV Report [systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile for age, gender and height]. We also compared the performance of HBPi with other simplified indices such as the BP/height ratio and the absolute height-specific BP thresholds. Ten pediatrics' outpatient centers participating in the "CARdiometabolic risk factors in ITALY study" provided medical records of 4225 Ow/Ob children and adolescents (age 6-16 years).
Centers were divided into two groups: training set (TS) (n = 2204 participants) and validation set (VS) (n = 2021 participants). The simplified HBPi (mmHg) was: (SBP/2 + DBP/10) - age + (1 × female gender). In the TS, a HBPi value ≥57 mmHg in both children and adolescents had high sensitivity (0.89), specificity (0.97), positive (0.89) and negative (0.97) predictive values in classifying youth at high risk of HTN compared with the IV Report. In the VS, the HBPi showed a better performance than high levels of BP/height ratio and height-specific BP thresholds in classifying individuals at risk of HTN: area under curves 0.95 (0.93-0.96), 0.80 (0.78-0.82), 0.76 (0.74-0.79), respectively; specificities 0.95 (0.94-0.96), 0.69 (0.67-0.72), 0.60 (0.57-0.62), respectively.
HBPi, combining SBP and DBP, gender and age, may help pediatricians to implement HTN screening in Ow/Ob youth.
高血压（HTH）是儿童肥胖常见的并发症。为简化超重/肥胖（Ow/Ob）青少年高血压的筛查，我们比较了一种新指标（高血压指数，HBPi）与IV报告标准标准（收缩压（SBP）和/或舒张压（DBP）≥年龄、性别和身高的第95百分位数）的性能。我们还比较了HBPi与其他简化指标的性能，如血压/身高比和绝对身高特异性血压阈值。参与“意大利心脏代谢危险因素研究”的10个儿科门诊中心提供了4225名Ow/Ob儿童和青少年（6 - 16岁）的病历。
中心分为两组：训练集（TS）（n = 2204名参与者）和验证集（VS）（n = 2021名参与者）。简化的HBPi（mmHg）为：（SBP/2 + DBP/10） - 年龄 + （1×女性性别）。在TS中，与IV报告相比，儿童和青少年的HBPi值≥57 mmHg在对高血压高风险青少年进行分类时具有高敏感性（0.89）、特异性（0.97）、阳性（0.89）和阴性（0.97）预测值。在VS中，HBPi在对高血压风险个体进行分类时表现优于高水平的血压/身高比和身高特异性血压阈值：曲线下面积分别为0.95（0.93 - 0.96）、0.80（0.78 - 0.82）、0.76（0.74 - 0.79）；特异性分别为0.95（0.94 - 0.96）、0.69（0.67 - 0.72）、0.60（0.57 - 0.62）。
结合SBP和DBP、性别和年龄的HBPi可能有助于儿科医生对Ow/Ob青少年进行高血压筛查。
