51 and 0.58 mmHg/cm VE-821 in females. SBPHR cutoff values for elevated SBP were 0.76 and 0.88 in males, and 0.78 and 0.90 in females.14 The National Health

and Nutrition Examination Survey (NHANES) in 2006-2007 included the data of 3,775 American children and adolescents, and confirmed the high sensitivity and specificity of BPHR in detecting elevated BP in this age group. The cutoffs for SBPHR and DBPHR were ≥ 0.75 and ≥ 0.46 in males, and ≥ 0.75 and ≥ 0.48 in females, respectively. 15 In all these studies, 8, 9, 14 and 15 as well as in the current study, the cutoff points obtained are in a similar range, and BPHRs had high accuracy in identifying elevated BP in the pediatric age group. The similarity of the indexes obtained in the present and in previous studies, as well as the appropriate sensitivity and specificity of these indexes in all these studies, indicates that simple indexes of BPHR can be used in various populations of children and adolescents. Currently, a large number of children

and adolescents with pre-HTN and HTN remain undiagnosed. This problem is not restricted to low- and middle-income countries with limited health care facilities; even physicians with access to electronic files and computer programs in industrialized countries still have difficulties with integrating BP monitoring of children and adolescents into their routine clinical practice.16 Providing simple indexes for BPHR would help the Selleck BGB324 implementation of scientific guidelines for routine measurement and tracking of BP from childhood. By considering the strong effects of overweight, and environmental factors such as air pollution, noise pollution, and passive smoking on elevated BP,17, 18 and 19 it is suggested that the prevalence of pre-HTN and HTN will continue to increase in the pediatric age group. Moreover, elevated BP has various adverse effects even in children and adolescents.20 Thus, using simplified diagnostic tools for SBPHR and DBPHR would help to screen and identify children and adolescents

who need further assessment for elevated BP. It should be acknowledged that obtaining BPHR indexes requires Suplatast tosilate the measurement of both BP and height, and also requires the calculation of their ratio; thus, they are subject to measurement error. BPHR indexes cannot be considered as substitutes of the age- and gender-specific BP percentiles in the diagnosis of elevated BP, but they can be easily used as screening tools. The optimal thresholds of SBPHR and DBPHR for defining elevated BP were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds,8, 9, 14 and 15 thus it is suggested that the use of these simple, inexpensive, and accurate indexes should be standardized into screening programs for elevated BP in the pediatric age group. This study was conducted as part of a national school-based survey. The authors declare no conflicts of interest.