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Oscillometric 24-h ambulatory blood pressure reference values in Hong Kong Chinese children and adolescents

Yip, Gabriel W.K.a; Li, Albert M.b; So, Hung-Kwanb; Choi, Kai C.c; Leung, Lettie C.K.d; Fong, Nai-Chunge; Lee, Kwok-Waif; Li, Samantha P.S.g; Wong, Sik-Ning; Sung, Rita Y.T.b

doi: 10.1097/HJH.0000000000000062
ORIGINAL PAPERS: Children and adolescents

Objectives: We aimed to establish community-based normal reference values of 24-h ambulatory blood pressure monitoring (ABPM) for Chinese children and adolescents. Furthermore, we investigated how excluding overweight children affects BP percentiles and compared them with German references.

Methods: In this territory-wide cross-sectional prospective cohort study, 1445 Hong Kong Chinese children and adolescents aged 8–17 years with body height between 119 and 185 cm were recruited. Their ABPM assessment was performed using validated arm oscillometric recorders (A&D TM-2430) and complied with American Heart Association's recommendations. The reference tables were constructed using the LMS method to normalize skewed distribution of ABP data to sex and age or height.

Results: The ambulatory BP was higher among boys and the difference between boys and girls progressively widened with age. An increasing trend in daytime and night-time SBP and DBP with age and height was observed in both sexes. The age-specific and sex-specific 95th percentiles from nonoverweight children (n = 1147; 79%) were lower than the whole cohort by up to 2.5 and 1 mmHg for SBP and DBP, respectively. In comparison, our overall and nonoverweight reference standards were generally higher than corresponding German references.

Conclusion: The study provides ambulatory BP standards for Chinese children, with sex-related age-specific and height-specific percentiles. Further longitudinal studies are required for investigating its clinical utility in Chinese.

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aDivision of Cardiology, Department of Medicine and Therapeutics

bDepartment of Paediatrics

cThe Nethersole School of Nursing, The Chinese University of Hong Kong, Prince of Wales Hospital

dDepartment of Paediatrics, Kwong Wah Hospital

eDepartment of Paediatric and Adolescent Medicine, Princess Margaret Hospital

fDepartment of Paediatrics, Queen Elizabeth Hospital

gDepartment of Paediatric and Adolescent Medicine, Tuen Mun Hospital, Hong Kong Special Administrative Region, Peoples’ Republic of China

Correspondence to Professor Rita Yn-Tz Sung, Division of Cardiology, Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Peoples’ Republic of China. Tel: +852 2637 6527; fax: +852 2636 0020; e-mail:

Abbreviation: ABPM, ambulatory blood pressure monitoring

Received 15 July, 2013

Accepted 28 October, 2013

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© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins