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Critical Care

Open Access

Update of the pediatric hypotension graphic adjusted for gender and height percentiles: diastolic blood pressure for boys, 1 to 17 years old

  • HH Shieh1,
  • ER Barreira1,
  • A Bousso1,
  • AC Ventura1 and
  • EJ Troster1
Critical Care201317(Suppl 3):P20

Published: 19 June 2013


According to the National Heart, Lung, and Blood Institute of the National Institute of Health, hypotension refers to an abnormally low blood pressure (BP). In childhood, hypotension can be determined according to two different definitions: BP below the 5th percentile or below two standard deviations (SDs) of the mean for age and gender [1]. A graphic representation of pediatric hypotension was published in 1977 [2], and no updates have been published since then.

The objective of this study was to update the graphic representation of pediatric hypotension.


We used a computerized calculation method to develop high-resolution graphics containing 5,841 points each, to depict the main percentiles associated with low BP for boys from 1 to 17 years old in the 50th percentile of height. Each point represents the calculation of the polynomial equation that includes the statistical processing of the last Report on Blood Pressure [3]. We also analyzed the effect of height on BP in the 5th to 95th percentile range. Statistical functions generated by computerized program were used.


Five monotonic curves of diastolic BP for boys representing the 50th, 25th, 10th, 5th, and 2.275th (-2SD) percentiles were built (Figure 1). Considering a tolerance of 1 mmHg, the monotonic curve of adjustment for height of the diastolic BP for boys does not need any correction in the 25.5th to 76th percentile of height, but needs maximal correction for the 5th percentile of height (-2.41 mmHg correction).
Figure 1

Graphic update of diastolic blood pressure (DBP) based on the last Report on Blood Pressure in 2004 [3], for boys 1 to 17 years old (50th percentile of height). Considering a tolerance of 1 mmHg, the curve of adjustment for height of the DBP for boys does not need any correction in the in the 25.5th to 76th percentile of height.


The correction of diastolic BP for height is of little significance, and this updated graphic can be used to diagnose low diastolic BP for boys. Clinical studies are necessary to determine the SBP percentile that better represents clinically significant hypotension.

Authors’ Affiliations

University Hospital of Universidade de São Paulo, Vila IaraSão Paulo, Brazil


  1. Shieh HH, Gilio AE, Barreira ER, Troster EJ, Ventura AMC, Goes PF, Souza DC, Sinimbu Filho JM, Bousso A: Pediatric hypotension: quantification of the differences between the two current definitions. Intensive Care Med 2012,38(Suppl 1):S0662. doi: 10.1007/s00134-012-2683-0Google Scholar
  2. Blumenthal S, et al.: Report of the Task Force on Blood Pressure Control in Children. Pediatrics 1977,59(Suppl):797.Google Scholar
  3. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents Pediatrics 2004,114(Suppl 4th Report):555-576.Google Scholar


© Shieh et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.