Establishing nomogram of blood pressure for late adolescents in India: Secondary analysis of NFHS-4 data

BACKGROUND: Hypertension among adolescents is a public health problem, which is going to become more severe given the current obesity epidemic. There is a scarcity of information on the reference range value for blood pressure (BP) cut-off for adolescents. AIM: We aimed to establish BP distribution in adolescents aged 15–19 years by using the nationally representative National Family Health Survey-4 (NFHS-4) data. MATERIALS AND METHODS: We analyzed the data of 15,936 boys and 1,04,132 girls aged 15–19 years in the NFHS-4 survey. We took the mean of systolic and diastolic BPs. Height for age z scores for each individual was calculated using the WHO Anthro plus. The sampling weight was taken as provided by the demographic and health surveys (DHS) website. Nomograms of systolic and diastolic BPs were made by calculating their 50(th), 90(th), and 95(th) percentiles for each age (in months), gender, and height percentile for age categories. RESULTS: Both systolic and diastolic BPs increased with age and height centiles. The BP was higher in boys than girls. The average annual increase in systolic and diastolic BPs was 2.52 and 1.20 mmHg in boys and 0.50 and 0.46 mmHg in girls, respectively, when adjusted for height centiles. CONCLUSION: This study provides a BP nomogram that can be generalized to all the Indian population. Research is required for the diagnostic performance of this nomogram for the diagnosis of adolescent hypertension.