Abstract
Accurate blood pressure reference values are crucial for detecting hypertension in children. However, international guidelines, with reference values based on multiethnic US cohorts, may not be fully applicable in other populations. This study primarily aimed to develop percentile-based population-specific oscillometric blood pressure reference values for Danish children and, secondly, to compare these to existing percentile-based international reference values. A cross-sectional study was conducted using data from the Lolland-Falster Health Study (2016-2020), including 1771 children aged 4-15 years. A reference model was developed based on 1512 children of normal weight, excluding those with chronic conditions, blood pressure-altering medications, or a country of origin other than Denmark. Quantile regression models estimated sex- and age-specific 5th to 95th percentile for systolic and diastolic blood pressure. Reference values were compared in reclassification tables. The novel Danish reference model provides percentile-based age- and sex-specific oscillometric office blood pressure reference values. Excluding height from the model had minimal impact on explanatory power. Applying international reference values identified 27% to 69% of the Danish children with blood pressure at or above the 95th percentile, when using the novel Danish reference values as an internal comparative benchmark. CONCLUSION: This study provided percentile-based reference values for oscillometric office blood pressure screening in children and adolescents of Danish origin and demonstrated that applying international reference values across different pediatric populations and measurement modalities may carry risk of misclassification. These findings suggest a need for population-tailored reference values in improving the diagnosis and management of hypertension in children and adolescents. WHAT IS KNOWN: • Current international pediatric blood pressure guidelines are based on percentile-based reference values derived from US multiethnic cohorts. • These reference values may not accurately reflect other populations, leading to potential misclassification. WHAT IS NEW: • The novel Danish age- and sex-specific reference values, provided in this study, can be used in the assessment of oscillometric blood pressure measurements for screening purposes. • The novel oscillometric reference values are easy to apply and might reduce the risk of underdiagnosis.