A comparison of blood pressure reference values and the prevalence of high blood pressure in Indian adolescents aged 10–16 years using American and Indian reference standards

다국어 초록 (Multilingual Abstract)

Background: High blood pressure (BP) in children and adolescents is a major public health concern globally, including in India. It is typically defined by BP > 95th percentile of normative BP distribution, with the American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG 2017) being most widely used. However, Indian-specific reference derived from healthy children set higher BP cut-offs than AAP-CPG 2017, leading to debate about their suitability. This study compares high BP prevalence using both references and examines how each classification by the 2 reference standards relates to cardiometabolic risk factors.
Methods: A secondary analysis of cross-sectional data from the Comprehensive National Nutrition Survey (2016–2018) was conducted to compare the prevalence of high BP in Indian adolescents aged 10–16 years using Indian and AAP-CPG 2017 references. The association between cardio-metabolic risk markers and high BP classified by these references was examined by survey weighted multiple log-binomial regression to examine the validity of each reference standard.
Results: In young adolescents aged 10–12 years, the prevalence of high BP was 16% (95% confidence interval [CI], 13.6–19%) and 33.6% (95% CI, 30.4–37%) by Indian and AAP-CPG reference respectively. Similarly, in older adolescents aged 13–16 years, the prevalence of high BP was lower with Indian reference. The adjusted risk ratios (ARRs) for high triglycerides, total cholesterol, and low-density lipoprotein were significantly elevated in young adolescents with high BP by AAP-CPG 2017 reference but not with Indian reference.
Conclusions: The prevalence of high BP among Indian adolescents differed significantly based on the BP reference standard used. Clustering of cardiometabolic risk markers with high BP was observed when using the AAP-CPG reference but not with Indian reference. However, these findings should be interpreted cautiously given the cross-sectional study design with single visit BP measurement and limited generalizability of the Indian BP reference standard. Larger, nationally representative studies using standardized BP measurement methods are essential to establish validated BP norms for Indian adolescents.