Normalized maximal blood pressure at peak exercise in healthy children
Presented By:
Tara Iyengar, MD; Lisa Lattera, MS; Nandini Madan, MD
Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, Illinois; Heart Center for Children, St. Christopher’s Hospital for Children – Tower Health, Philadelphia, Pennsylvania; Drexel University College of Medicine, Philadelphia, Pennsylvania
iyengar.tara@gmail.comOverview:
Background: Exercise testing in pediatric patients has widespread clinical utility, however published normative data is limited, making the results of pediatric exercise testing difficult to standardize and interpret. Large scale studies for normalized maximal blood pressures by age, sex, and body mass index (BMI) within a diverse pediatric population are needed. This study aims to establish values for maximum blood pressure during peak exercise, by reporting age, sex, and BMI stratified normalized maximal blood pressure values in healthy pediatric patients undergoing exercise testing.
Methods: This study was a chart review of exercise tests performed by either Bruce treadmill or bicycle ramp exercise study protocol at St. Christopher’s Hospital for Children between 1/1/2008 and 11/18/2019. Children aged 7-14 years old (yo) with normal cardiac structure and function confirmed by echocardiogram, who reached at least 85% of maximum predicted heart rate for age, were included in the study. Patients with a history of congenital heart disease, abnormal cardiac structure or function confirmed on echocardiogram, or those on an anti-hypertensive or anti-arrhythmic medication were excluded. Patient age, sex, BMI, and blood pressure at peak exercise were collected.
Results: There were a total of 883 patients included in the study, of whom 58% were male and 42% were female. In general, when stratified by age in years and sex, peak systolic and diastolic blood pressure values across all percentiles (50th, 90th, and 95th), increased by age. Male patients typically had a higher systolic and diastolic peak blood pressure than female patients at each age, with some exceptions.
Patients were then classified into one of three age groups- <9yo, 9-12 yo, and 12-14yo, and one of three BMI status groups- healthy (<85th percentile BMI for age), overweight (85th to <95th percentile BMI for age), and obese (95th or higher percentile BMI for age). Peak blood pressure percentiles were then reported for each of the three age groups, stratified further by sex and BMI group. Peak systolic and diastolic blood pressure for each percentile generally increased by age group and by BMI group, with the highest peak pressures in the obese groups, next highest in the overweight groups, followed by the healthy BMI groups. This effect was seen across females and males, and males generally had higher peak blood pressures than females in almost all cases.
Conclusions: As age and BMI status increases in females and males, there is an increase in peak blood pressure (particularly systolic). This study encompasses a heterogeneous population in Northeast Philadelphia, providing more widely applicable data than previous studies, which are based on homogenous populations. This is a limited study focusing on patients aged 7-14yo. The study population is large, however a larger, heterogeneous population is needed to establish more reliable blood pressure parameters at peak exercise, especially in the <9yo age group. Given that the blood pressures were obtained by listening to the Korotkoff sounds, and not using an electronic device, they are more accurate, however there is a possibility for error based on use of improper blood pressure cuff size.
Methods: This study was a chart review of exercise tests performed by either Bruce treadmill or bicycle ramp exercise study protocol at St. Christopher’s Hospital for Children between 1/1/2008 and 11/18/2019. Children aged 7-14 years old (yo) with normal cardiac structure and function confirmed by echocardiogram, who reached at least 85% of maximum predicted heart rate for age, were included in the study. Patients with a history of congenital heart disease, abnormal cardiac structure or function confirmed on echocardiogram, or those on an anti-hypertensive or anti-arrhythmic medication were excluded. Patient age, sex, BMI, and blood pressure at peak exercise were collected.
Results: There were a total of 883 patients included in the study, of whom 58% were male and 42% were female. In general, when stratified by age in years and sex, peak systolic and diastolic blood pressure values across all percentiles (50th, 90th, and 95th), increased by age. Male patients typically had a higher systolic and diastolic peak blood pressure than female patients at each age, with some exceptions.
Patients were then classified into one of three age groups- <9yo, 9-12 yo, and 12-14yo, and one of three BMI status groups- healthy (<85th percentile BMI for age), overweight (85th to <95th percentile BMI for age), and obese (95th or higher percentile BMI for age). Peak blood pressure percentiles were then reported for each of the three age groups, stratified further by sex and BMI group. Peak systolic and diastolic blood pressure for each percentile generally increased by age group and by BMI group, with the highest peak pressures in the obese groups, next highest in the overweight groups, followed by the healthy BMI groups. This effect was seen across females and males, and males generally had higher peak blood pressures than females in almost all cases.
Conclusions: As age and BMI status increases in females and males, there is an increase in peak blood pressure (particularly systolic). This study encompasses a heterogeneous population in Northeast Philadelphia, providing more widely applicable data than previous studies, which are based on homogenous populations. This is a limited study focusing on patients aged 7-14yo. The study population is large, however a larger, heterogeneous population is needed to establish more reliable blood pressure parameters at peak exercise, especially in the <9yo age group. Given that the blood pressures were obtained by listening to the Korotkoff sounds, and not using an electronic device, they are more accurate, however there is a possibility for error based on use of improper blood pressure cuff size.
