1. Development of blood
pressure percentile tables for
children from African and
Caribbean backgrounds living
in the UKEva A-Attah (MB BS, MPH)
Institute for Health Research & Policy
12th
November 2010

2. Outline For Presentation
 Background
 Aims & Objectives
 Method
 Results
 Summary of findings
 Conclusion/Recommendation

3. BACKGROUND
 High BP(Hypertension)
– World #1 cause of
death.
 Hypertension=
sustained raised
systolic and diastolic
BP
 High prevalence of
Hypertension in UK.
-32% men & 30%
women,71%(over 75’s)
 Effects of High BP

4. High BP in Caribbean & African Children
Higher prevalence of
hypertension in Caribbean &
Africans than Caucasians
observed.
Obesity predisposes to high
BP in children.
Association between adult
and childhood BP established.

5. Childhood BP Monitoring
 BP Monitoring - Best way to
diagnose hypertension.
 Parameters for BP
monitoring in children (age,
gender & height)
 Height impt to avoid
misclassification.
 CDC-US has developed BP
tables for girls and boys.

6. Objectives
-To develop BP percentile tables for African
and Caribbean children for easy monitoring of
their BP.
-To identify African and Caribbean children
aged 5-18yrs with abnormally high BP.
-To ascertain the BP levels of African and
Caribbean children for clinical and research
purposes.

7. Subjects and methods
 Raw data was obtained from the Health Survey for
England 1991 to 2008.
 The data was sorted to obtain a total of 900 African and
Caribbean children aged 5 – 18 years.
 The Normal Distribution of the data was verified using
LMS method which is based on the British 1990
reference data.
 Diastolic and systolic blood pressures as well as height,
weight and body mass index of the children were
retrieved for analysis using SPSS version 17. Out of the
total number of children, 99% had valid parameters
which could be analysed.

8. Methods cont.
 The analysis of the data entailed the sorting out
of the data into various age groups and gender.
 For each age group and gender, the 50th, 75th,
90th and 95th height percentile were determined
 Then for each height percentile of a particular
age group and gender, the respective 50th,
90th, 95th and 99th percentile of both the
systolic and diastolic pressures determined.
 The results were then tabulated.

9. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 5-8 YEARS
MALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
5
50th 99 102 101 102 52 52 53 55
90th 104 104 105 105 68 67 66 68
95th 104 104 107 107 68 68 68 72
99th 104 104 107 107 68 68 68 72
6
50th 101 102 102 102 59 59 59 59
90th 128 126 125 125 74 74 73 72
95th 128 128 128 128 74 76 75 75
99th 128 128 128 128 74 78 78 78
7
50th 106 106 108 108 60 58 58 58
90th 120 122 122 122 72 72 73 73
95th 120 126 124 124 73 73 74 74
99th 120 130 130 130 73 74 75 75
8
50th 107 107 107 108 62 60 61 62
90th 120 116 120 122 81 76 74 73
95th 120 120 122 138 81 81 81 81
99th 120 120 122 138 81 81 81 81

10. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 9-12 YEARS
MALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
9
50th 111 111 111 111 61 61 61 60
90th 115 116 118 120 71 75 74 73
95th 119 118 120 123 78 78 78 78
99th 119 119 120 123 78 79 79 79
10
50th 108 112 109 110 62 61 59 59
90th 132 131 127 126 76 73 70 70
95th 137 134 132 132 81 78 77 76
99th 137 137 137 137 82 82 82 82
11
50th 108 110 109 110 56 58 57 57
90th 127 121 120 122 65 71 69 68
95th 134 132 129 128 66 72 72 72
99th 134 134 134 134 66 72 72 72
12
50th 114 114 111 113 58 58 57 58
90th 123 127 124 123 71 76 73 72
95th 128 128 128 128 77 82 82 82
99th 128 128 128 128 77 82 82 82

11. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 13-15 YEARS
MALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
13
50th 116 119 120 120 62 62 62 61
90th 138 138 138 138 65 67 68 68
95th 138 139 138 138 67 69 69 69
99th 138 139 139 139 67 69 70 70
14
50th 115 118 118 119 55 55 55 56
90th 128 131 130 131 75 75 75 75
95th 137 150 146 144 76 85 83 81
99th 137 156 156 156 76 90 90 90
15
50th 112 114 114 112 55 55 53 54
90th 126 126 126 126 64 63 63 63
95th 126 132 131 130 64 64 64 64
99th 126 133 133 133 64 64 64 64

12. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 16-18 YEARS
MALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
16
50th 116 117 117 116 53 53 53 53
90th 130 131 129 128 72 70 69 69
95th 134 133 133 133 79 77 76 76
99th 134 134 134 134 79 79 79 79
17
50th 119 118 118 118 57 60 61 61
90th 133 133 133 133 82 76 75 77
95th 136 135 135 140 87 85 84 84
99th 136 136 136 143 87 87 87 87
18
50th 119 120 120 120 73 66 62 64
90th 133 138 136 143 76 75 75 75
95th 133 139 139 146 76 76 76 76
99th 133 139 139 146 76 76 76 76

13. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 5-8 YEARS
FEMALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
5
50th 105 104 104 104 57 56 56 56
90th 118 110 106 106 80 71 68 68
95th 121 121 121 121 84 84 84 84
99th 121 121 121 121 84 84 84 84
6
50th 106 103 104 103 58 57 57 57
90th 113 113 113 113 67 67 67 67
95th 117 116 117 117 67 70 70 70
99th 117 117 117 117 67 72 72 72
7
50th 106 106 107 106 61 61 61 61
90th 110 112 113 113 76 76 76 76
95th 112 113 118 118 76 76 77 77
99th 112 113 118 118 76 76 81 81
8
50th 104 104 104 104 61 62 63 63
90th 115 116 116 116 74 70 69 72
95th 116 119 119 119 76 76 76 76
99th 116 119 119 119 76 76 76 76

14. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 9-12 YEARS
FEMALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
9
50th 104 104 104 105 56 56 55 56
90th 119 119 119 119 65 63 65 66
95th 120 119 119 128 66 65 66 66
99th 120 120 120 128 66 66 66 66
10
50th 106 109 109 110 57 57 59 58
90th 120 120 120 120 72 69 72 71
95th 120 122 122 122 77 74 74 73
99th 120 122 122 122 77 77 77 77
11
50th 114 110 110 109 60 60 60 60
90th 125 122 127 126 70 67 70 70
95th 129 129 131 130 76 71 74 74
99th 129 129 131 131 78 78 78 78
12
50th 109 110 110 111 54 56 54 56
90th 127 127 128 127 65 77 75 74
95th 127 128 128 128 73 80 80 80
99th 127 128 128 128 73 80 80 80

15. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 13-15
YEARS
FEMALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
13
50th 108 110 111 113 59 59 59 59
90th 119 124 124 123 74 70 68 68
95th 122 124 124 124 76 76 76 75
99th 122 124 124 124 76 76 76 76
14
50th 112 116 118 118 59 59 59 60
90th 139 132 131 130 65 66 69 68
95th 140 140 140 140 67 69 82 82
99th 140 140 140 140 68 73 82 82
15
50th 114 114 114 115 59 59 59 59
90th 127 127 127 127 63 69 70 70
95th 127 127 127 127 67 71 79 76
99th 127 127 127 127 67 71 91 91

16. RESULTS
TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 16-18
YEARS
FEMALES
Age BP Percentile
SBP, mmHg DBP, mmHg
Percentile of Height Percentile of Height
50th 75th 90th 95th 50th 75th 90th 95th
16
50th 115 116 116 117 54 59 63 63
90th 128 128 129 128 76 74 74 74
95th 128 132 135 133 77 77 77 77
99th 128 132 151 151 77 77 77 77
17
50th 116 117 114 115 56 56 56 58
90th 128 135 135 133 74 72 71 71
95th 139 137 137 136 78 76 76 75
99th 139 139 139 139 78 78 78 78
18
50th 116 118 117 118 64 64 64 63
90th 129 134 131 134 71 75 75 75
95th 132 143 143 143 77 81 79 78
99th 132 143 143 143 77 83 83 83

17. Summary of findings
 BP increased with age.
 No significant difference with gender.
 BP did not consistently increase with height
-compared to US data.
 Body weight is the major factor influencing
BP.

18. Conclusions
 BP percentiles tables & charts for African and
Caribbean children can be produced.
 Potential to develop BP reference tables
based on gender and age.
 Sample size was too small to detect variation
in BP in the African and Caribbean children.

19. Recommendation
The persisting high rates of cardiovascular
diseases and hypertension epidemic calls for
continuing research to focus attention on
blood pressure tracking from childhood to
adulthood.