Development of age-specific and sex-specific blood pressure norms and their associations with lipid profile in children aged 6-16 years from urban Bengaluru: a cross-sectional study.

Abstract

Paediatric hypertension is a significant health problem, with elevated childhood blood pressure (BP) linked to adult hypertension and increased cardiovascular risk. Existing reference guidelines from the American Academy of Pediatrics (AAP) may not be appropriate for Indian children, emphasising the need to develop region-specific normative data. (1) To derive population-specific BP percentiles for children from urban Bengaluru, aged 6-16 years, compare these to the AAP reference guidelines; (2) to estimate and compare the proportion of hypertension identified using the derived percentiles versus AAP reference guidelines and (3) to examine the association of elevated BP with lipid profiles. Cross-sectional observational study. Urban school-based setting in Bangalore, India. Apparently healthy school-going children (n=9051), aged 6-16 years were included. Children with known chronic illnesses or conditions affecting BP were excluded. None. Sex-specific, age-specific and height-specific systolic BP (SBP) and diastolic BP (DBP); proportion of BP categories (normal, elevated, hypertensive) using AAP reference guidelines and the study-derived percentiles with Centers for Disease Control and Prevention (CDC) and Indian Academy of Pediatrics (IAP) height centiles; proportion of abnormal lipid profiles. The study-derived SBP and DBP percentiles increased steadily with age in both sexes, differing from the percentiles of AAP reference guidelines. Using AAP reference guidelines, 14.1% of children had elevated BP and 23.9% had hypertension, compared with 6.9% and 8.1%, using study-derived percentiles. Proportion of hypertension estimated from the derived BP percentiles using CDC and IAP height centiles were similar (p=0.178). Elevated BP was significantly associated with a higher proportion of abnormal total cholesterol (8.6% vs 3.2%, p=0.027) and higher low-density lipoprotein-cholesterol levels, predominantly among girls. The study developed updated age-sex and height-specific BP percentiles for Indian children. Findings indicate that elevated BP may coexist with adverse lipid profiles, suggesting early clustering of cardiometabolic risk factors in this population.