Reference values for exercise blood pressure in adolescents

In children and adolescents, office blood pressure (BP) is not very reliable
and has a poor reproducibility. In case of adults, exercise BP correlates
more closely with cardiovascular risk and there are cut-off values for ex-
ercise BP which indicate normal and reference values. However, there re no reference values for children and adolescents, to date. The goal of
the present investigation was a proposal for exercise BP reference values
for adolescents. In the Kiel EX.PRESS. (EXercise and PRESSure) study,
systolic BP at rest and during exercise of 532 young subjects (aged 12-
17 years) were determined. Systolic exercise BP was measured at 1.5
Watt / kg body weight using a standardized cycle ergometer exercise test.
Mean resting BP was 113.1±12.8 / 57.2±7.1 mmHg, while mean exercise BP was 149.9±19.8 / 54.2±8.6 mmHg. For the determination of
reference values, the German age-, height- and sex-related reference per-
centiles for resting BP were used. The BP values at the 90th and the
95th percentile were taken to determine the respective percentiles in our
study group. The corresponding percentiles were 87.6 and 92.1, therefore
according to German reference values which are very similar to interna-
tional data 12.4% of the subjects had at least a high normal resting BP
and 7.9% had hypertension. The systolic exercise BP values at these per-
centiles for our sample are proposed as reference values for high normal
exercise BP and exercise hypertension (see table 1). Using these reference
values, 79% of our participants had normal resting and exercise BP values.
7.8% had normal resting but high normal or hypertensive exercise BP
values. 7.4% of the subjects were high normal or hypertensive at rest
but normotensive during exercise. Additional 5.9% had both high normal
or hypertensive resting and exercise BP values.
Exercise BP might be useful to identify white coat hypertension in a sub-
group of young subjects. It is also relevant for the better determination of
cardiovascular risk using the proposed reference values for 12-17 year-old
subjects. As long as prognostic data for reference values in adolescents are
missing, these statistical reference values might be useful in clinical
practice