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J Pediatr (Rio J). 2014 Jan-Feb;90(1):85-91. doi: 10.1016/j.jped.2013.06.005. Epub 2013 Oct 13.

First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study.

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Pediatrics Department, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran.
Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran; Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran.
School Health Department, Bureau of Health and Fitness, Ministry of Education, Tehran, Iran.
Environment Department, Environment Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Pediatrics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Pediatrics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:



This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents.


The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves.


The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTN were 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%.


BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group.


Adolescence; Adolescência; Blood pressure; Hipertensão; Hypertension; Pre-hypertension; Pressão sanguínea; Pré-hipertensão; Screening; Triagem

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