Blood Pressure Percentiles in 22,051 German Children and Adolescents: The PEP Family Heart Study

BACKGROUND Strong associations between blood pressure (BP) and overweight raise the question whether overweight children (body mass index (BMI) >= 85th percentile) should be included in the normative database. METHODS Using the LMS (Lamda-Mu-Sigma) method, we developed age-, gender-, and height-adjusted percentile curves for systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the 50th, 85th, 90th, 95th, and 97th percentiles in 22,051 German youths (18,917 normal-weight, 1,938 overweight, and 1,196 obese) aged 3-18 years from yearly cross-sectional surveys of the PEP Family Heart Study Nuremberg. RESULTS Among children, we found no gender differences for BP and BMI. Male adolescents are taller and heavier. The mean prevalence of hypertension and obesity is 7.3% and 5.2% among children and 7.2% and 5.8% among adolescents, respectively. The prevalence of elevated BP increased substantially by weight groups achieving 24.4% in obese females and 21.9% in obese males with odds ratios of 5.9 (95% confidence interval (CI): 5.1-7.5) and 4.3 (95% CI: 3.5-5.2), respectively. The shapes of the 10 LMS-smoothed SBP and DBP percentile curves differ substantially between gender and weight group. The normal-weight percentiles are nearly identical with the overall growth charts, but separate percentiles for overweight and obese youths provide considerably higher values, such as 148/91 vs. 136/86 mm Hg for a 17-year-old male and 136/91 vs. 123/81 mm Hg for female, respectively, at the 90th percentile. CONCLUSIONS Because of substantially higher BP percentiles, separate databases for overweight and obese children and adolescents are strongly recommended.