The goal was to create normal blood pressure (BP) charts that represented BP percentile curves similar to CDC growth charts to improve child screening for high and low BP. Height-specific BP percentile curves were constructed separately for boys and females since height accounts for significantly greater BP variability than age and is a more direct marker of body size and maturation in youngsters. To determine the BP threshold value for each gender and 5 cm height group, Researchers used the data source and equations from the 2004 Fourth Report. These charts ensured 100% sensitivity in detecting abnormal BP by slightly underestimating a child’s BP percentile for high BP and slightly overestimating a child’s BP percentile for low BP. In a sample of 1,254 healthy youngsters from a school-based blood pressure monitoring program, they validated the chart cut-offs’ sensitivity and specificity.

The 1st, 5th, 25th, 50th, 75th, 90th, 95th, and 99th BP, Hypotension, normal BP, prehypertension, stage 1 hypertension, and Stage 2 hypertension were all differentiated by shaded areas on the chart. The sensitivity was 100%, with a specificity of over 94%. These simplified BP charts had the following features: longitudinal BP tracking in a single child; a full physiological range of BP percentiles represented in percentile curve format for rapid identification of both high and low BP; a full physiological range of BP percentiles represented in percentile curve format for quick identification of both high and low BP; a full physiological range of BP percentiles represented in percentile curve format for rapid identification of both high and low BP; simple to use with absolute height alone, obviating the need to calculate height percentiles, the inclusion of an adult pre-hypertension threshold to aid in the accurate transition from adolescence to adulthood;  High sensitivity and specificity to ensure that all at-risk children were detected with minimal false positives.

Reference:bmcpediatr.biomedcentral.com/articles/10.1186/s12887-016-0633-7