International Blood Pressure References for Children

Study Questions:

What are the global distributions of blood pressure (BP) percentiles for children and adolescents?


Data from 52,636 non-overweight children and adolescents (ages 6-19 years) were collected from seven large cross-sectional surveys conducted in seven countries: China, India, Iran, Korea, Poland, Tunisia, and the United States. BP measures were collected in a standardized fashion using certified mercury sphygmomanometers. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated using the Generalized Additive Model for Location Scale and Shape (GAMLSS) model.


In this data set of over 50,000 children, BP values were similar between males and females until the age of 13 years. After that, BP values were higher in males than females. Compared to BP level of the 90th and 95th percentiles of the US Fourth Report (which has been commonly used as normative data) at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. In comparing the data from different countries, for median systolic BP, Poland had the highest values for both sexes at a given age, while Korea, Iran, and China had the lowest values. For median diastolic BP, India had the highest values for both sexes, whereas the United States had the lowest values.


The investigators concluded that these international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents, and may help identify hypertensive youths in diverse populations.


Data from seven different countries help to provide a global perspective to distributions of BP among children and adolscents. Such data are vital to the assessment of public health.

Clinical Topics: Prevention, Hypertension

Keywords: Blood Pressure, Blood Pressure Determination, Hypertension, Pediatrics, Primary Prevention, Public Health, Sphygmomanometers

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