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Update of the pediatric hypotension graphic adjusted for gender and height percentiles: diastolic blood pressure for girls, 1 to 17 years old
Critical Care volume 17, Article number: P23 (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 . A graphic representation of pediatric hypotension was published in 1977 , 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 curves with 5,841 points each, to depict the main percentiles associated with low BP for girls 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 in 2004 . We also analyzed the effect of height on BP from the 5th to 95th percentile. Statistical functions generated by computerized program were used.
Five monotonic curves of diastolic BP for girls 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 DBP for girls does not need any correction in the 16th to 78.5th percentile of height, but needs maximal correction for the 95th percentile of height (+2.08 mmHg correction).
The correction of female diastolic BP for height is of minimal significance, and this updated graphic can be used to diagnose low diastolic BP for girls. Clinical studies are necessary to determine the diastolic BP percentile that better represents clinically significant hypotension.
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 Medicine 2012.,38(Suppl 1): S0662. doi: 10.1007/s00134-012-2683-0
Blumenthal S, et al.: Report of the Task Force on Blood Pressure Control in Children. Pediatrics 1977,59(Suppl):797.
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.
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Shieh, H., Barreira, E., Bousso, A. et al. Update of the pediatric hypotension graphic adjusted for gender and height percentiles: diastolic blood pressure for girls, 1 to 17 years old. Crit Care 17, P23 (2013). https://doi.org/10.1186/cc12639
- Blood Pressure
- Diastolic Blood Pressure
- Graphic Representation
- Blood Institute
- Computerize Program