Blood pressure references for children and adolescents in Germany and international comparisons

Objectives: The 2009 European Society of Hypertension Guidelines on the management of high blood pressure (BP) in children and adolescents recommend the current US 2004 references because European references by age and height simultaneously do not exist. We present new German BP references by age and height simultaneously and draw international comparisons. Methods: We used data of the nationally representative KiGGS study with standardised BP measurements for children and adolescents aged 3-<18 years with an oscillometric device validated for children (Datoscope Accutorr Plus). Percentiles were fitted using the LMS and GAMLSS methods. KiGGS BP references by age and height simultaneously are presented for non-overweight children (BMI <5 years and for SBP in boys >14 years. At median height according to CDC charts, the difference for P95 ranges by age for systolic BP from –4 to +4mmHg in boys and –2 to +1mmHg in girls; and for diastolic BP from –6 to +2mmHg in boys and –5 to +2mmHg in girls. KiGGS confirms that paediatric systolic BP is not normally distributed and BP variance is not the same at all ages as assumed in the US 2004 references. Older European references by de Man et al. are higher than KiGGS (both with and without overweight children). British and regional US percentiles based on measurements with the Dinamap device, which has known limitations, both show very similar departures from the KiGGS percentile shape. Conclusions: The cornerstones of paediatric BP references are sampling, measurement and statistical methods.