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

Abstract

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.

Introduction

Hypertension among adolescents is a growing public health problem,[1] which persists in their adulthood and old age. Given the current obesity epidemic, the burden of adolescent hypertension can be expected to increase. The prevalence of clinical hypertension in children and adolescents is ∼3.5% and the prevalence of persistently elevated blood pressure (BP) is ∼2.2 to 3.5%, with higher rates among overweight and obese children and adolescents.[2]

The causes for hypertension among adolescents may be primary (or essential) or secondary due to other diseases. Secondary hypertension is more common than primary among adolescents which is in sharp contrast to adults.[3] The initiating process which leads to changes in trophins such as insulin-like growth factor-1, cortisol, catecholamines, and angiotensin has possible long-term effects which may also lead to progressive changes in the blood vessels’ structure and other cardiovascular effects.[4]

The diagnosis of hypertension and elevated BP in children or adolescents is made when there are three different BP readings and ≥90^th percentile, respectively. The updated definition of BP categories and stages according to the American Academy of Pediatrics (AAP) and National High Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents is provided in Table 1.[2,5]

Table 1.

BP categories and stages according to the AAP and NHBPEP

Blood pressure categories	Children aged ≥13 years (AAP)	NHBPEP
Normal BP	<120/<80 mmHg	SBP or DBP <90th percentile for age and height percentile
Elevated BP	120/<80 mmHg-129/<80 mmHg	SBP or DBP between 90th and 95th percentile for age and height percentile
Stage 1 HTN	130/80-139/89 mmHg	SBP or DBP between 95th and 99th percentile for age and height percentile
Stage 2 HTN	≥140/90 mmHg	SBP or DBP >99th percentile for age and height percentile

These reference values are derived from a multi-ethnic pediatric population from the USA. Because of the influence of multiple factors like race, ethnicity, genetic and environmental determinants, the reference standards of one population might not be relevant in others.[6,7] There is a very limited number of studies to establish a reference standard for BP distribution among adolescents in India and these studies were conducted on a small scale with small sample size. Establishing a nomogram of BP of adolescents requires consideration of a few factors. Age is one of the main determinants of BP values.[8] BP increases with age and more abruptly during puberty. Another important determinant is sex, with a higher prevalence of hypertension among boys. Height also determines the value of BP.[6] Other risk factors for hypertension in children include obesity, race, ethnicity, disordered sleep, family history of hypertension, low-birth weight, and maternal smoking during pregnancy.[1] Data tracking from childhood to adulthood has shown that high BP in childhood correlates with higher BP in adulthood. Hence, the diagnosis and treatment of hypertension are of paramount importance in late adolescents.[2]

Thus, in the present study, 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

Data source and sample size

The NFHS is a nationally represented, large-scale survey conducted in multiple rounds. The NFHS-4 was conducted by the International Institute of Population Sciences (IIPS) and Ministry of Health and Family Welfare, India, from January 2015 to December 2016, covering approximately 6 lakh households. NFHS-4 was representative at the level of districts. A total of 7 lakh women and about 1.1 lakh men were interviewed using a structured tool. Men and women between 15 and 19 years of age were considered and the rest were omitted. Data on BP mainly came from the household member dataset.

Data collection

The piloting of NFHS-4 was conducted before the survey which included 147 household interviews (including BP measurement in 181 adults). Along with this, three ToT (training of trainers) were conducted by International Institute for Population Sciences (IIPS). The trainers who participated were responsible for training all field workers throughout India. The biomarker measurement training and procedures are explained in detail in the NFHS-4 biomarker questionnaire.[9]

Before measuring BP, the arm circumference was measured to use an appropriate size cuff. Systolic and diastolic BPs were measured thrice using a standard digital sphygmomanometer (Portable Omron BP monitor, model HEM-8712) on the same arm, with an interval of at least 5 min between each BP measurement. The participants were asked to sit and relax for 5 min before taking the first reading.[9]

Data analysis and statistical methods

Data were analyzed in STATA v. 12 (StataCorp, College Station, Tx).[10] Age was calculated by date of birth and date of interview to get age in completed months. We took the mean of systolic and diastolic BP readings. Those with systolic BP more than 270 mmHg or less than 40 mmHg, and diastolic BP more than 140 mmHg or less than 10 mmHg were omitted from the analysis. If a reading was missing, we took the mean of the remaining readings. We calculated height for age z scores using the WHO Anthro plus macro.[11] Individuals with height for age z score less than -5 and more than +5 were omitted from the analysis. Survey methods were used for estimating the centile values of systolic and diastolic BP. The height for age z-scores were converted to height for age centiles and categorized (Supplementary Tables S1–S4). Sampling weights were considered for multi-stage sampling and clustering. Appropriate sampling weights (hv028 and hv005) were considered for men and women, respectively. The primary sampling unit and strata were defined as provided on the DHS website.[12] Stata command “svyset” with “centered” option was used due to single strata within a few primary sampling units. Then, the 50^th, 90^th, and 95^th percentile systolic and diastolic BP values were calculated and tabulated separately for males and females, for each age (in months) and height percentile category. For depicting the nomogram of BP for the age chart, we used the Lowess method for smoothing the curve. We depicted the nomogram of systolic and diastolic BPs against age (in months) for the 50^th centile for height for each sex.

Table S1.

Systolic Blood Pressure centiles for boys

Age (months)	n	Height centile	SBP 5th centile	SBP 50th centile	SBP 90th centile	SBP 95th centile	SBP 99th Centile
180	245	5	92.0	106.3	122.0	122.7	132.0
180	245	25	95.0	109.7	123.0	125.7	132.7
180	245	50	95.7	110.5	123.0	125.7	132.7
180	245	75	95.7	112.0	124.0	126.3	132.7
180	245	95	95.7	112.0	124.0	126.3	132.7
181	370	5	94.0	108.7	123.0	125.7	131.7
181	370	25	94.0	109.7	123.3	126.0	132.0
181	370	50	94.0	110.3	123.7	126.3	132.3
181	370	75	94.0	110.3	124.0	127.5	134.3
181	370	95	94.0	110.3	124.0	127.5	134.3
182	337	5	89.7	106.3	120.0	123.0	136.7
182	337	25	93.0	110.7	122.7	127.3	142.3
182	337	50	93.3	111.0	122.7	127.3	142.3
182	337	75	94.0	111.3	122.7	126.3	142.3
182	337	95	93.3	111.5	122.7	128.0	142.3
183	304	5	93.0	110.7	120.0	123.0	134.0
183	304	25	93.3	110.7	120.7	125.7	140.7
183	304	50	93.3	111.0	122.0	126.3	138.3
183	304	75	93.7	111.7	123.7	128.0	136.3
183	304	95	94.3	112.3	123.7	128.0	136.3
184	298	5	90.0	107.3	123.0	124.3	132.7
184	298	25	91.7	110.3	123.3	131.0	133.3
184	298	50	93.3	110.3	124.3	131.0	134.7
184	298	75	93.3	110.3	125.7	131.0	135.7
184	298	95	93.7	110.7	125.7	131.0	135.7
185	310	5	94.3	110.0	122.3	125.3	134.0
185	310	25	94.7	112.0	124.0	125.3	131.7
185	310	50	95.3	111.0	123.3	125.3	131.7
185	310	75	96.0	112.3	124.3	126.3	131.7
185	310	95	96.0	112.3	124.3	126.3	134.7
186	261	5	92.0	109.3	118.3	126.0	136.0
186	261	25	95.0	109.3	121.7	126.0	136.0
186	261	50	95.3	110.0	124.3	130.0	141.3
186	261	75	95.3	111.0	124.7	129.7	141.3
186	261	95	95.3	111.0	125.0	131.3	141.3
187	324	5	90.3	109.3	126.0	130.7	146.3
187	324	25	94.0	111.0	125.7	127.0	135.5
187	324	50	94.3	112.0	125.7	130.7	138.7
187	324	75	94.3	112.0	126.0	131.7	138.7
187	324	95	94.3	112.0	126.0	131.7	138.7
188	297	5	95.0	109.7	122.7	126.3	153.7
188	297	25	95.0	111.3	122.7	128.7	153.7
188	297	50	95.0	112.0	122.7	127.7	144.0
188	297	75	95.3	112.0	122.7	128.3	144.3
188	297	95	95.7	112.0	122.7	128.3	144.3
189	344	5	94.0	110.7	123.0	127.0	144.0
189	344	25	96.0	110.7	124.3	129.3	144.0
189	344	50	96.3	111.3	125.7	129.3	144.0
189	344	75	96.3	111.3	125.7	129.3	144.0
189	344	95	96.3	111.3	125.7	129.3	144.0
190	368	5	92.3	110.3	128.7	130.3	134.7
190	368	25	93.0	112.3	130.0	133.3	151.3
190	368	50	95.3	111.7	129.0	133.3	151.3
190	368	75	96.0	112.7	130.0	134.0	151.3
190	368	95	96.0	112.7	130.0	134.0	151.3
191	328	5	96.7	110.0	123.7	127.7	130.0
191	328	25	97.0	111.0	126.0	129.0	161.7
191	328	50	97.7	112.0	127.3	129.7	140.7
191	328	75	97.7	112.7	128.0	129.7	138.3
191	328	95	97.7	112.7	128.0	130.0	138.3
192	365	5	94.3	110.0	121.7	129.7	134.7
192	365	25	96.0	113.0	125.3	132.7	135.7
192	365	50	96.0	113.3	126.0	132.7	135.7
192	365	75	96.0	113.3	126.0	132.7	135.7
192	365	95	96.0	113.3	126.0	132.7	135.7
193	361	5	95.7	109.7	124.7	130.3	136.0
193	361	25	95.7	111.7	126.5	131.7	141.7
193	361	50	95.7	111.7	126.7	131.7	141.7
193	361	75	95.0	111.3	126.7	131.7	141.7
193	361	95	95.0	111.3	126.7	131.7	140.3
194	362	5	96.7	113.0	122.3	125.3	133.0
194	362	25	96.3	113.3	123.7	126.7	137.7
194	362	50	96.3	113.0	124.0	127.3	138.3
194	362	75	95.7	113.3	124.3	128.3	138.3
194	362	95	95.7	113.3	124.3	128.3	138.3
195	301	5	96.3	113.0	125.0	130.7	138.3
195	301	25	95.0	111.7	124.0	127.7	137.7
195	301	50	96.0	112.3	124.0	127.7	137.7
195	301	75	96.3	113.0	125.3	129.0	137.7
195	301	95	96.3	113.0	126.0	129.0	137.7
196	290	5	90.7	109.7	124.7	128.7	135.3
196	290	25	93.3	113.0	126.3	128.7	135.7
196	290	50	95.7	114.0	126.0	128.0	135.7
196	290	75	96.0	114.0	126.3	129.3	136.0
196	290	95	96.0	114.0	126.3	129.3	136.0
197	290	5	96.3	112.0	125.3	128.3	134.7
197	290	25	98.0	114.3	125.0	128.3	134.7
197	290	50	98.0	114.3	125.0	129.0	136.3
197	290	75	98.0	114.7	125.3	130.3	138.0
197	290	95	98.0	114.7	125.3	130.3	138.0
198	287	5	98.3	115.3	126.0	128.7	137.0
198	287	25	98.3	116.3	125.0	128.7	136.3
198	287	50	98.3	115.7	126.0	128.7	137.7
198	287	75	98.3	116.3	126.0	128.7	137.0
198	287	95	98.3	116.3	126.0	129.0	137.7
199	313	5	98.0	113.7	124.0	133.3	144.7
199	313	25	97.0	113.3	126.3	133.3	142.0
199	313	50	98.0	113.3	126.3	133.3	142.0
199	313	75	96.7	113.3	126.3	133.3	141.0
199	313	95	96.7	113.3	126.3	133.3	141.0
200	319	5	97.0	116.3	129.0	132.3	135.3
200	319	25	97.3	115.0	128.3	132.3	145.7
200	319	50	97.3	115.0	129.0	132.7	145.7
200	319	75	97.3	115.3	129.0	132.7	145.7
200	319	95	97.3	115.3	129.3	132.7	145.7
201	345	5	98.3	111.3	127.3	137.0	139.0
201	345	25	98.0	113.0	127.3	131.3	139.0
201	345	50	98.0	113.3	128.7	133.3	143.7
201	345	75	98.0	113.3	128.7	133.3	143.7
201	345	95	98.0	113.3	128.7	133.3	143.7
202	328	5	99.0	114.0	126.7	129.0	146.3
202	328	25	100.0	115.3	128.3	132.3	146.3
202	328	50	100.0	116.0	129.0	134.0	149.7
202	328	75	100.0	116.0	129.0	134.0	149.7
202	328	95	100.0	116.0	129.0	134.0	149.7
203	301	5	93.3	115.0	127.0	133.0	141.7
203	301	25	94.0	115.0	130.0	134.3	150.0
203	301	50	95.0	115.0	130.0	135.7	151.0
203	301	75	95.0	115.3	129.3	134.3	151.0
203	301	95	95.0	115.3	130.0	134.3	151.0
204	379	5	99.0	114.0	123.3	126.7	152.0
204	379	25	99.0	114.3	124.7	131.7	149.7
204	379	50	99.0	114.7	125.7	131.7	149.7
204	379	75	99.0	114.7	125.7	132.0	149.7
204	379	95	99.3	114.7	126.0	132.0	149.7
205	305	5	101.7	114.0	128.0	131.0	138.3
205	305	25	100.7	114.7	127.3	130.0	138.0
205	305	50	100.7	114.3	126.7	131.0	138.3
205	305	75	100.7	114.7	127.7	131.7	140.3
205	305	95	100.7	114.7	127.7	131.7	140.3
206	315	5	95.7	115.3	126.3	130.7	135.0
206	315	25	98.3	115.3	126.3	130.7	143.0
206	315	50	99.7	115.3	126.3	130.0	143.0
206	315	75	98.3	115.3	126.3	130.7	143.0
206	315	95	98.3	115.3	126.7	130.7	143.0
207	294	5	97.0	115.7	131.0	131.7	143.0
207	294	25	97.0	117.7	129.0	131.7	135.3
207	294	50	97.0	117.7	129.0	131.7	135.3
207	294	75	97.0	117.0	129.0	131.7	135.3
207	294	95	97.0	117.0	129.0	131.7	135.3
208	261	5	98.7	116.7	125.0	131.0	152.7
208	261	25	97.7	116.3	128.0	133.0	146.3
208	261	50	98.0	116.3	128.3	131.7	146.3
208	261	75	98.0	116.3	128.3	131.7	146.3
208	261	95	98.0	116.3	128.3	131.7	146.3
209	274	5	98.7	115.7	127.7	130.0	135.7
209	274	25	100.0	116.7	129.7	134.7	140.7
209	274	50	101.0	117.0	129.7	133.3	140.7
209	274	75	100.3	117.0	128.7	133.3	140.7
209	274	95	100.3	117.0	128.7	132.0	140.7
210	262	5	99.0	115.3	128.0	132.7	139.0
210	262	25	99.3	115.0	131.0	133.7	140.7
210	262	50	97.7	114.3	128.0	133.0	143.0
210	262	75	97.7	114.3	128.0	133.7	144.7
210	262	95	98.3	114.3	128.0	133.7	144.7
211	327	5	98.0	114.0	130.0	134.7	140.0
211	327	25	98.3	115.0	131.7	137.0	142.3
211	327	50	99.7	115.0	131.7	137.3	145.0
211	327	75	99.7	115.3	133.0	139.3	145.0
211	327	95	100.0	115.3	132.7	138.0	145.0
212	312	5	100.3	112.3	127.3	131.0	136.3
212	312	25	94.7	112.7	128.0	132.3	140.3
212	312	50	97.0	114.0	129.3	132.3	140.5
212	312	75	97.3	114.0	129.3	132.3	140.5
212	312	95	97.3	114.3	129.3	131.7	140.5
213	307	5	91.3	114.0	127.7	132.3	143.0
213	307	25	96.7	115.7	129.7	134.3	143.0
213	307	50	97.0	116.7	129.3	134.0	143.0
213	307	75	97.0	116.7	129.3	134.0	143.0
213	307	95	97.0	116.7	129.3	134.0	143.0
214	361	5	102.0	117.0	130.3	132.3	138.7
214	361	25	100.7	117.0	130.0	132.7	138.7
214	361	50	100.3	116.3	130.3	133.0	140.3
214	361	75	100.7	116.3	130.0	133.0	140.3
214	361	95	100.7	116.3	130.0	133.0	140.3
215	323	5	97.7	116.0	127.0	131.7	138.0
215	323	25	99.0	116.3	129.5	135.0	142.0
215	323	50	100.0	116.0	129.0	134.7	142.0
215	323	75	100.3	116.3	128.3	134.7	142.0
215	323	95	100.3	116.3	128.3	134.7	142.0
216	370	5	97.3	114.3	127.7	131.0	139.0
216	370	25	97.3	115.7	129.0	134.0	140.7
216	370	50	97.3	116.7	129.0	133.7	140.7
216	370	75	97.3	116.7	129.7	134.7	140.7
216	370	95	97.3	116.7	130.3	134.7	140.7
217	418	5	98.3	115.0	126.3	130.7	143.3
217	418	25	98.0	115.3	128.0	133.0	143.3
217	418	50	98.0	115.3	130.0	133.3	143.3
217	418	75	98.3	115.3	130.3	133.3	143.3
217	418	95	98.3	115.3	130.3	133.3	143.3
218	393	5	98.3	117.0	128.0	136.7	142.7
218	393	25	99.0	117.0	128.3	132.3	142.7
218	393	50	101.0	117.0	129.0	134.0	142.7
218	393	75	101.3	117.0	129.7	134.0	142.7
218	393	95	101.3	117.0	129.7	134.0	142.7
219	365	5	97.7	115.3	125.7	128.0	145.3
219	365	25	99.3	115.7	128.3	131.3	138.3
219	365	50	99.3	115.7	128.3	131.3	138.3
219	365	75	99.3	115.7	128.3	131.3	138.3
219	365	95	99.3	115.7	128.3	131.3	138.3
220	312	5	97.3	116.7	127.3	132.0	135.7
220	312	25	99.0	115.0	129.3	133.0	139.0
220	312	50	98.3	115.0	129.3	132.3	139.0
220	312	75	98.3	115.0	129.3	132.3	139.0
220	312	95	98.7	115.0	129.3	132.3	139.0
221	291	5	102.0	118.0	129.3	132.3	137.7
221	291	25	100.7	117.7	129.3	133.7	145.3
221	291	50	101.0	118.0	129.7	134.0	147.3
221	291	75	101.0	117.7	129.3	134.0	147.3
221	291	95	101.0	118.0	129.7	134.0	147.3
222	292	5	100.3	118.0	129.7	133.3	146.7
222	292	25	101.0	117.7	128.3	132.0	143.0
222	292	50	101.0	118.0	129.0	133.0	146.7
222	292	75	101.0	118.0	129.0	133.3	144.0
222	292	95	101.0	118.0	129.0	133.3	144.0
223	308	5	102.3	118.7	131.7	133.3	147.7
223	308	25	101.0	118.3	132.0	134.3	147.7
223	308	50	102.3	118.0	131.7	134.3	147.7
223	308	75	102.3	118.3	131.7	134.3	147.7
223	308	95	102.3	118.3	131.7	134.3	147.7
224	358	5	100.7	118.0	129.7	133.3	141.7
224	358	25	100.7	117.7	129.3	133.3	143.3
224	358	50	100.7	117.7	129.3	133.0	141.7
224	358	75	100.7	117.7	129.3	133.0	141.7
224	358	95	100.7	117.7	129.3	132.3	141.7
225	382	5	101.7	117.3	129.7	132.0	143.7
225	382	25	101.7	117.7	130.0	132.3	142.0
225	382	50	101.7	117.3	129.7	133.0	142.0
225	382	75	101.7	117.0	129.7	132.3	142.0
225	382	95	101.7	117.0	129.7	132.3	141.3
226	386	5	100.0	118.3	131.7	137.3	142.7
226	386	25	100.0	118.3	133.3	137.0	142.7
226	386	50	100.0	118.3	133.0	137.3	143.3
226	386	75	100.0	118.3	133.0	137.3	142.7
226	386	95	100.0	118.3	133.0	137.3	142.7
227	373	5	99.7	115.7	129.0	131.3	139.0
227	373	25	102.0	117.3	130.7	133.7	142.3
227	373	50	101.0	117.7	130.0	133.7	142.3
227	373	75	102.0	118.0	131.0	133.7	142.3
227	373	95	102.0	118.0	131.0	133.7	142.3
228	320	5	99.7	117.0	131.5	138.3	148.7
228	320	25	99.7	117.7	132.7	137.7	148.7
228	320	50	101.0	118.3	133.7	137.0	148.7
228	320	75	99.7	118.3	133.0	137.0	148.7
228	320	95	99.7	118.3	133.0	137.0	148.7

Table S4.

Diastolic Blood Pressure Centiles for girls

Age (months)	n	Height centile	DBP 5th centile	DBP 50th centile	DBP 90th centile	DBP 95th centile	DBP 99th centile
180	1,486	5	58.3	69.7	79.7	82.0	92.7
180	1,486	25	57.7	70.0	79.7	82.7	90.3
180	1,486	50	57.7	70.0	79.7	83.0	90.3
180	1,486	75	58.0	70.0	79.7	83.3	90.3
180	1,486	95	57.7	70.0	79.7	83.0	90.3
181	2,310	5	58.7	70.7	81.0	83.7	91.0
181	2,310	25	58.0	70.5	80.7	83.3	89.7
181	2,310	50	58.0	70.7	80.7	83.0	89.7
181	2,310	75	58.3	70.7	80.7	83.3	89.7
181	2,310	95	58.3	70.7	80.7	83.3	89.7
182	2,159	5	58.0	70.7	80.3	83.0	90.7
182	2,159	25	58.0	70.7	80.3	84.0	91.0
182	2,159	50	58.0	70.7	80.3	84.0	91.7
182	2,159	75	58.0	70.7	80.3	84.3	91.7
182	2,159	95	58.0	70.7	80.3	84.3	91.7
183	2,154	5	58.0	70.0	80.0	83.3	90.7
183	2,154	25	58.3	70.0	80.0	83.3	92.0
183	2,154	50	58.3	70.3	80.3	83.5	92.0
183	2,154	75	58.3	70.3	80.3	83.7	92.0
183	2,154	95	58.3	70.3	80.3	83.7	92.0
184	2,084	5	58.3	70.0	80.0	83.7	97.7
184	2,084	25	57.7	70.0	79.7	83.0	94.0
184	2,084	50	57.7	69.7	79.7	83.0	94.0
184	2,084	75	57.3	69.7	79.7	83.0	94.0
184	2,084	95	57.7	69.7	79.7	83.0	94.0
185	1,930	5	59.0	70.7	80.0	82.5	89.0
185	1,930	25	59.0	70.7	80.7	83.3	91.0
185	1,930	50	58.7	70.7	80.7	83.3	92.0
185	1,930	75	59.0	70.7	80.7	83.3	92.0
185	1,930	95	59.0	70.7	80.7	83.3	92.0
186	1,974	5	58.3	71.0	81.3	84.0	93.3
186	1,974	25	59.0	70.7	81.0	84.0	96.0
186	1,974	50	58.7	71.0	81.0	84.0	94.3
186	1,974	75	58.7	71.0	81.0	84.0	94.3
186	1,974	95	58.7	71.0	81.0	84.0	94.3
187	2,056	5	60.0	70.3	81.0	83.7	92.3
187	2,056	25	60.0	70.7	81.0	85.0	91.7
187	2,056	50	59.7	71.0	81.0	85.0	92.0
187	2,056	75	59.7	71.0	81.0	84.7	91.7
187	2,056	95	59.7	70.7	81.0	84.7	91.7
188	2,167	5	58.0	71.0	81.7	84.7	91.0
188	2,167	25	58.7	70.3	81.0	84.0	91.7
188	2,167	50	58.7	70.3	80.7	83.7	91.3
188	2,167	75	58.7	70.3	80.7	83.7	91.0
188	2,167	95	58.7	70.3	81.0	83.7	91.0
189	2,309	5	58.7	70.7	81.7	84.3	95.0
189	2,309	25	58.7	71.0	81.3	84.3	94.3
189	2,309	50	58.7	71.0	81.3	84.3	94.3
189	2,309	75	58.7	71.0	81.3	84.7	95.0
189	2,309	95	58.7	71.3	81.3	84.7	95.0
190	2,351	5	59.3	71.0	81.0	84.7	97.3
190	2,351	25	58.7	71.0	81.0	84.0	93.0
190	2,351	50	58.7	71.0	81.0	84.0	93.0
190	2,351	75	58.7	71.0	81.0	84.0	93.0
190	2,351	95	58.7	71.0	81.0	84.0	93.0
191	2,416	5	58.0	70.3	81.0	84.3	92.0
191	2,416	25	58.7	70.7	81.3	84.3	92.0
191	2,416	50	58.7	70.7	81.0	84.0	92.0
191	2,416	75	58.7	70.7	81.0	84.3	92.0
191	2,416	95	58.7	70.7	81.0	84.0	92.0
192	2,487	5	58.0	71.3	82.0	84.7	93.3
192	2,487	25	58.3	71.0	81.3	84.3	91.7
192	2,487	50	58.3	71.0	81.7	84.7	92.0
192	2,487	75	58.3	71.0	81.7	84.7	91.7
192	2,487	95	58.3	71.0	81.7	84.7	91.7
193	2,155	5	55.7	71.0	80.7	84.0	91.3
193	2,155	25	56.0	71.0	80.7	84.0	91.3
193	2,155	50	56.3	71.0	80.7	84.0	90.7
193	2,155	75	56.3	71.0	80.7	83.7	90.7
193	2,155	95	56.3	71.0	80.7	83.7	90.7
194	2,150	5	58.0	70.7	80.3	83.3	91.3
194	2,150	25	58.3	71.0	80.5	83.3	91.7
194	2,150	50	58.3	71.3	80.7	83.7	92.0
194	2,150	75	58.7	71.3	80.7	83.7	92.0
194	2,150	95	58.7	71.3	80.7	84.0	92.0
195	2,032	5	58.3	71.0	81.0	83.7	93.3
195	2,032	25	58.0	71.0	81.0	84.0	93.3
195	2,032	50	58.3	71.0	81.0	84.0	93.3
195	2,032	75	58.3	71.0	81.0	84.0	93.3
195	2,032	95	58.3	71.0	81.0	84.0	93.3
196	1,942	5	59.7	70.0	80.7	83.0	91.5
196	1,942	25	59.0	70.7	80.7	83.3	94.0
196	1,942	50	59.0	70.7	80.7	83.0	93.3
196	1,942	75	59.0	70.3	80.7	83.0	93.3
196	1,942	95	59.0	70.3	80.7	83.0	93.3
197	1,945	5	59.0	70.7	81.3	84.3	89.7
197	1,945	25	59.0	71.0	81.3	84.5	92.0
197	1,945	50	59.3	71.0	81.3	84.5	92.7
197	1,945	75	59.3	71.0	81.3	84.5	92.7
197	1,945	95	59.3	71.0	81.3	84.5	92.7
198	1,853	5	60.0	71.0	81.7	83.7	89.3
198	1,853	25	59.7	71.3	81.3	84.0	88.3
198	1,853	50	59.7	71.3	81.3	84.3	89.3
198	1,853	75	59.7	71.3	81.5	84.3	89.3
198	1,853	95	59.7	71.3	81.3	84.3	89.3
199	1,925	5	58.7	71.7	82.3	86.7	98.0
199	1,925	25	58.7	71.3	82.3	86.0	98.0
199	1,925	50	58.7	71.7	82.3	85.3	98.0
199	1,925	75	58.7	71.7	82.3	85.3	98.0
199	1,925	95	59.0	71.7	82.3	85.3	98.0
200	2,077	5	59.0	71.7	81.3	84.7	92.0
200	2,077	25	58.7	71.7	81.7	84.7	92.0
200	2,077	50	58.7	71.7	81.7	84.7	92.3
200	2,077	75	58.7	71.3	81.7	84.7	92.0
200	2,077	95	58.7	71.3	81.7	84.7	92.0
201	2,193	5	59.7	71.7	81.7	85.7	95.3
201	2,193	25	59.7	71.7	81.3	85.3	94.3
201	2,193	50	59.7	71.7	81.3	85.0	94.3
201	2,193	75	59.7	71.7	81.3	85.0	93.7
201	2,193	95	59.7	71.7	81.3	85.0	93.7
202	2,344	5	59.7	71.0	80.3	83.0	89.0
202	2,344	25	59.0	71.0	80.7	83.7	90.0
202	2,344	50	59.0	71.0	80.7	83.7	90.3
202	2,344	75	59.0	71.0	80.3	83.7	90.3
202	2,344	95	59.0	71.0	80.7	83.7	90.3
203	2,176	5	59.0	71.3	81.7	85.0	93.3
203	2,176	25	59.0	71.3	81.3	84.7	93.0
203	2,176	50	59.3	71.3	81.3	84.3	92.3
203	2,176	75	59.3	71.3	81.7	84.3	92.3
203	2,176	95	59.3	71.3	81.7	84.3	92.3
204	2,331	5	57.3	71.0	81.3	84.7	92.5
204	2,331	25	58.3	71.0	81.3	84.7	92.5
204	2,331	50	58.7	71.0	81.3	84.7	92.5
204	2,331	75	58.7	71.0	81.3	84.7	92.7
204	2,331	95	58.7	71.0	81.3	84.7	92.7
205	1,949	5	60.3	71.7	81.3	84.0	91.0
205	1,949	25	60.0	71.3	81.3	84.0	90.7
205	1,949	50	60.0	71.3	81.7	84.0	91.0
205	1,949	75	60.0	71.3	81.5	84.0	91.0
205	1,949	95	60.0	71.3	81.7	84.3	91.0
206	1,916	5	58.0	70.7	81.3	84.7	94.0
206	1,916	25	58.3	71.3	82.0	85.3	94.0
206	1,916	50	58.3	71.3	82.0	85.3	94.0
206	1,916	75	58.3	71.3	81.7	85.0	94.0
206	1,916	95	58.3	71.3	81.7	85.3	94.0
207	1,773	5	58.7	72.0	82.3	85.3	97.7
207	1,773	25	59.0	71.7	82.3	85.3	96.0
207	1,773	50	59.0	71.3	82.0	85.3	94.7
207	1,773	75	59.0	71.3	82.0	85.3	94.7
207	1,773	95	59.0	71.3	82.0	85.3	94.7
208	1,792	5	58.3	71.3	82.0	85.3	103.3
208	1,792	25	58.7	72.0	82.7	85.3	99.0
208	1,792	50	58.7	71.7	82.3	85.3	96.3
208	1,792	75	58.7	71.7	82.3	85.0	96.0
208	1,792	95	58.7	71.7	82.3	85.3	96.0
209	1,683	5	59.3	71.3	82.0	85.0	93.0
209	1,683	25	59.3	71.0	82.0	84.7	93.3
209	1,683	50	59.5	71.3	82.0	84.7	93.0
209	1,683	75	59.5	71.3	82.0	85.0	93.3
209	1,683	95	59.5	71.3	82.0	85.0	93.3
210	1,686	5	59.0	71.7	81.0	85.0	96.7
210	1,686	25	58.7	71.3	81.0	85.3	93.3
210	1,686	50	58.7	71.3	81.0	85.3	93.3
210	1,686	75	59.0	71.3	81.0	85.3	94.0
210	1,686	95	59.0	71.3	81.0	85.3	94.0
211	1,923	5	58.7	71.7	81.0	84.0	93.0
211	1,923	25	59.0	71.3	81.7	84.7	92.7
211	1,923	50	59.0	71.7	82.0	85.0	93.7
211	1,923	75	58.7	71.7	82.0	85.0	93.7
211	1,923	95	58.7	71.7	82.0	85.0	93.7
212	1,991	5	59.0	72.0	82.7	85.3	94.7
212	1,991	25	59.0	71.7	82.3	85.3	93.7
212	1,991	50	59.3	71.7	82.3	85.3	93.7
212	1,991	75	59.3	71.7	82.3	85.3	93.0
212	1,991	95	59.3	71.7	82.3	85.3	93.0
213	2,159	5	59.3	71.7	82.7	86.3	104.3
213	2,159	25	59.7	71.7	82.3	85.7	97.3
213	2,159	50	59.3	71.3	82.0	85.3	95.0
213	2,159	75	59.3	71.3	82.0	85.3	95.0
213	2,159	95	59.3	71.3	82.0	85.3	95.0
214	2,224	5	59.3	72.0	81.7	85.3	96.0
214	2,224	25	59.0	72.0	82.3	85.0	96.0
214	2,224	50	59.0	71.7	82.3	85.0	96.0
214	2,224	75	59.0	71.7	82.3	85.0	96.0
214	2,224	95	59.0	71.7	82.3	85.0	96.0
215	2,117	5	59.7	71.7	82.0	84.0	93.3
215	2,117	25	59.7	71.7	82.0	84.0	92.0
215	2,117	50	59.7	71.7	82.0	84.0	91.7
215	2,117	75	59.7	71.7	82.0	84.3	91.7
215	2,117	95	59.7	71.7	82.0	84.0	91.7
216	2,481	5	59.0	71.3	83.0	86.0	93.7
216	2,481	25	58.0	71.3	82.7	85.3	92.3
216	2,481	50	58.0	71.3	82.3	84.7	92.3
216	2,481	75	58.0	71.3	82.3	84.7	92.3
216	2,481	95	58.0	71.3	82.3	84.7	92.3
217	2,421	5	59.3	72.0	82.0	85.7	94.3
217	2,421	25	59.3	72.3	82.3	85.7	93.3
217	2,421	50	59.7	72.3	82.3	85.7	93.3
217	2,421	75	59.7	72.3	82.3	85.7	92.7
217	2,421	95	59.7	72.3	82.3	85.7	92.7
218	2,364	5	59.0	72.7	82.7	85.3	94.3
218	2,364	25	59.7	72.3	82.7	85.3	95.0
218	2,364	50	59.7	72.3	82.7	85.3	94.3
218	2,364	75	59.7	72.3	82.7	85.3	94.3
218	2,364	95	59.7	72.3	82.7	85.3	94.3
219	2,163	5	59.7	72.3	82.3	85.3	91.3
219	2,163	25	59.3	72.3	82.7	85.3	91.7
219	2,163	50	59.7	72.3	82.7	85.3	92.3
219	2,163	75	59.7	72.3	82.7	85.3	92.3
219	2,163	95	59.7	72.3	82.7	85.3	92.3
220	2,090	5	59.7	72.0	82.0	84.7	91.3
220	2,090	25	59.7	72.0	82.0	85.0	91.7
220	2,090	50	59.7	72.0	82.0	84.7	91.7
220	2,090	75	59.7	72.0	82.0	84.7	91.7
220	2,090	95	59.7	72.0	82.0	85.0	91.7
221	2,011	5	60.7	72.7	82.7	85.0	90.7
221	2,011	25	60.3	72.0	82.3	85.7	94.0
221	2,011	50	60.3	72.0	82.3	85.3	94.0
221	2,011	75	60.3	72.0	82.3	85.3	93.3
221	2,011	95	60.3	72.0	82.0	85.3	93.3
222	2,031	5	60.0	72.3	82.0	86.0	92.3
222	2,031	25	60.0	72.7	82.3	86.0	96.3
222	2,031	50	60.0	72.7	82.3	86.0	96.3
222	2,031	75	60.0	72.7	82.3	86.0	96.3
222	2,031	95	60.0	72.3	82.3	86.0	96.3
223	2,056	5	60.0	72.7	82.7	86.7	93.3
223	2,056	25	59.3	72.3	82.7	86.3	93.3
223	2,056	50	59.0	72.3	82.3	86.0	93.3
223	2,056	75	59.0	72.3	82.3	86.0	93.3
223	2,056	95	59.0	72.3	82.3	86.0	93.3
224	2,308	5	60.7	72.7	83.3	86.0	92.0
224	2,308	25	60.3	72.7	82.7	85.7	91.3
224	2,308	50	60.3	72.7	82.7	85.7	91.7
224	2,308	75	60.3	72.7	82.7	85.7	91.7
224	2,308	95	60.3	72.7	82.7	85.7	92.0
225	2,513	5	60.0	72.7	83.0	86.7	96.7
225	2,513	25	59.7	72.3	83.0	86.3	96.7
225	2,513	50	60.0	72.7	83.0	86.7	96.7
225	2,513	75	60.0	72.7	83.0	86.7	101.0
225	2,513	95	60.0	72.7	83.0	86.7	101.0
226	2,578	5	60.0	72.7	82.7	86.3	93.7
226	2,578	25	59.3	72.7	82.7	85.7	93.7
226	2,578	50	59.7	72.7	82.7	85.7	94.0
226	2,578	75	59.7	72.7	82.7	85.7	94.0
226	2,578	95	59.7	72.7	82.7	85.7	94.0
227	2,626	5	60.3	72.0	82.7	86.0	96.0
227	2,626	25	60.0	71.7	82.0	85.3	93.7
227	2,626	50	60.0	71.7	82.3	85.7	93.7
227	2,626	75	60.0	71.7	82.0	85.7	93.7
227	2,626	95	60.0	71.7	82.0	85.7	93.7
228	2,271	5	61.0	73.0	82.3	85.5	95.7
228	2,271	25	60.0	72.7	83.0	85.7	98.7
228	2,271	50	60.0	72.7	83.0	85.7	98.7
228	2,271	75	60.0	72.7	82.7	85.7	98.7
228	2,271	95	60.0	72.7	82.7	85.7	98.7

Table S2.

Diastolic Blood Pressure centiles for boys

Age (months)	n	Height centile	DBP 5th centile	DBP 50th centile	DBP 90th centile	DBP 95th centile	DBP 99th centile
180	245	5	56.7	70.0	80.7	82.3	97.0
180	245	25	56.7	70.0	80.0	81.3	85.0
180	245	50	57.7	71.0	80.7	82.3	85.0
180	245	75	56.7	71.0	81.0	83.0	92.3
180	245	95	57.7	71.0	81.0	83.3	92.3
181	370	5	53.7	69.0	80.3	83.7	93.3
181	370	25	55.3	70.0	79.7	82.3	86.0
181	370	50	56.0	70.3	80.3	83.0	90.0
181	370	75	56.7	71.0	80.3	83.0	90.0
181	370	95	56.7	71.0	80.3	83.0	90.0
182	337	5	55.0	69.0	77.7	81.3	89.0
182	337	25	56.0	70.7	80.0	83.0	89.0
182	337	50	56.0	70.0	79.3	83.0	89.0
182	337	75	56.0	70.3	79.3	83.0	89.0
182	337	95	56.0	70.3	79.3	82.3	89.0
183	304	5	57.0	68.7	77.0	80.0	88.3
183	304	25	57.0	69.0	78.0	82.7	90.7
183	304	50	58.0	69.0	78.3	82.7	96.0
183	304	75	58.0	69.3	78.3	82.7	96.0
183	304	95	58.0	69.0	78.3	82.7	96.0
184	298	5	54.3	68.5	80.3	83.0	93.0
184	298	25	56.3	69.0	80.0	82.3	93.0
184	298	50	57.0	69.3	80.3	83.0	92.7
184	298	75	56.7	69.3	80.3	83.3	90.7
184	298	95	56.7	69.3	80.3	83.3	90.7
185	310	5	59.3	71.3	80.3	83.7	95.7
185	310	25	58.5	71.0	83.0	84.0	94.0
185	310	50	58.5	70.0	81.0	83.7	94.3
185	310	75	58.0	70.0	80.7	83.0	94.3
185	310	95	58.0	70.0	81.0	83.7	94.3
186	261	5	60.0	71.0	80.3	82.0	84.0
186	261	25	58.0	71.3	80.0	82.0	86.3
186	261	50	58.0	71.3	80.7	82.3	86.0
186	261	75	58.0	71.0	80.7	82.7	86.3
186	261	95	58.0	71.0	81.0	83.0	86.3
187	324	5	57.3	69.3	81.3	89.3	98.7
187	324	25	58.0	70.3	82.3	85.3	91.3
187	324	50	57.3	70.7	81.7	82.7	91.3
187	324	75	58.0	70.7	81.7	82.7	91.3
187	324	95	58.0	70.7	81.7	82.7	91.3
188	297	5	59.7	69.0	78.7	81.0	95.7
188	297	25	59.7	69.7	78.7	80.3	88.7
188	297	50	59.7	69.7	78.7	80.7	88.7
188	297	75	59.7	69.7	79.0	81.0	88.7
188	297	95	59.7	69.7	79.0	81.0	88.7
189	344	5	59.3	70.0	81.0	85.0	102.3
189	344	25	58.7	69.7	81.7	86.0	102.3
189	344	50	58.0	69.3	81.3	85.0	94.0
189	344	75	58.0	69.3	81.3	85.0	94.0
189	344	95	58.0	69.0	81.3	85.0	94.0
190	368	5	56.0	69.5	82.7	86.3	90.7
190	368	25	57.3	70.7	82.0	85.7	90.7
190	368	50	56.0	70.7	82.0	85.7	89.3
190	368	75	57.0	70.7	82.0	85.7	90.7
190	368	95	57.0	70.7	82.0	85.7	90.7
191	328	5	62.0	72.7	80.0	82.0	88.3
191	328	25	60.0	70.3	80.0	82.7	88.3
191	328	50	58.0	71.3	80.3	82.7	88.3
191	328	75	59.0	71.3	81.0	82.7	88.0
191	328	95	59.0	71.3	81.3	83.0	87.0
192	365	5	59.7	71.0	78.7	81.0	84.7
192	365	25	58.7	71.3	80.7	82.3	89.0
192	365	50	59.7	72.0	81.0	83.0	89.0
192	365	75	59.7	72.0	80.7	83.0	89.0
192	365	95	59.7	72.0	80.7	83.0	89.0
193	361	5	56.3	70.7	83.0	90.3	113.7
193	361	25	56.3	70.0	82.3	90.0	113.7
193	361	50	56.3	70.0	82.3	90.0	113.7
193	361	75	57.3	69.7	81.5	90.0	113.7
193	361	95	57.3	69.7	82.3	89.0	113.7
194	362	5	58.3	71.7	81.7	83.3	88.3
194	362	25	58.7	71.7	81.0	82.7	93.0
194	362	50	58.7	71.3	81.3	83.7	93.3
194	362	75	58.7	71.7	81.7	84.0	93.3
194	362	95	58.7	71.3	81.7	84.0	93.3
195	301	5	54.3	72.3	81.0	82.3	90.0
195	301	25	54.3	71.3	80.0	82.7	90.0
195	301	50	54.3	70.0	79.3	81.7	90.0
195	301	75	54.7	70.0	80.0	84.0	91.0
195	301	95	54.7	70.3	80.0	84.3	91.0
196	290	5	58.3	69.7	80.7	87.0	106.0
196	290	25	58.7	70.0	82.7	87.0	93.0
196	290	50	58.7	70.7	82.0	85.7	93.0
196	290	75	58.7	71.0	82.0	86.0	93.0
196	290	95	58.7	71.0	82.0	86.0	93.0
197	290	5	57.0	71.0	81.7	83.3	87.3
197	290	25	59.7	71.0	81.3	83.0	87.0
197	290	50	58.3	71.0	81.3	83.0	87.3
197	290	75	59.7	71.0	81.3	83.3	88.0
197	290	95	59.7	71.0	81.3	83.3	88.0
198	287	5	60.7	70.3	81.0	82.0	86.0
198	287	25	60.3	71.7	80.3	82.0	91.3
198	287	50	59.7	71.7	81.0	83.7	93.3
198	287	75	59.7	72.0	81.0	83.7	93.3
198	287	95	59.7	72.0	81.3	84.0	93.3
199	313	5	58.5	72.7	84.0	90.3	98.7
199	313	25	58.7	73.7	83.0	88.3	98.7
199	313	50	58.7	73.3	82.7	88.0	98.7
199	313	75	58.7	73.3	83.0	87.3	98.7
199	313	95	58.7	73.3	83.0	87.3	98.7
200	319	5	58.3	71.7	80.0	84.3	94.3
200	319	25	58.3	71.0	80.0	83.7	90.3
200	319	50	58.3	71.0	80.0	83.7	93.0
200	319	75	58.3	71.0	80.0	83.7	93.0
200	319	95	58.3	71.0	80.0	83.7	93.0
201	345	5	56.7	70.3	82.0	88.0	110.0
201	345	25	58.3	71.0	82.7	86.7	110.0
201	345	50	58.3	71.0	83.3	87.0	110.0
201	345	75	58.3	71.0	83.3	86.7	110.0
201	345	95	58.3	71.0	83.0	86.7	110.0
202	328	5	59.3	72.7	81.0	85.7	101.0
202	328	25	60.7	73.0	82.3	86.3	97.0
202	328	50	61.0	73.7	83.0	86.7	94.7
202	328	75	61.0	73.7	82.7	86.3	94.7
202	328	95	61.0	73.7	82.7	86.3	94.7
203	301	5	58.7	72.3	82.0	84.7	90.7
203	301	25	58.7	71.0	82.0	84.7	94.3
203	301	50	58.7	71.3	82.0	84.7	94.3
203	301	75	58.7	71.0	82.0	84.7	94.3
203	301	95	58.7	71.0	81.7	84.7	94.3
204	379	5	60.0	71.7	81.3	85.0	93.3
204	379	25	60.0	71.7	80.7	84.7	89.0
204	379	50	60.0	71.7	80.7	84.7	90.0
204	379	75	60.0	71.7	81.0	84.7	93.3
204	379	95	60.0	71.7	80.7	84.7	93.3
205	305	5	60.7	74.0	83.0	84.3	91.0
205	305	25	60.3	73.7	82.7	84.3	92.7
205	305	50	60.0	74.0	83.0	84.3	92.7
205	305	75	59.7	74.0	83.0	85.3	93.0
205	305	95	60.0	74.0	83.0	85.3	93.0
206	315	5	60.3	73.0	83.7	87.0	90.0
206	315	25	59.3	72.3	82.3	85.7	90.0
206	315	50	59.0	72.3	82.3	85.0	90.0
206	315	75	59.0	72.0	82.3	85.7	90.0
206	315	95	59.0	72.0	82.3	85.7	90.0
207	294	5	52.0	72.3	81.3	84.3	89.3
207	294	25	55.0	72.7	81.7	85.3	89.7
207	294	50	55.3	72.3	81.7	85.0	89.7
207	294	75	55.3	72.3	81.7	85.0	89.7
207	294	95	58.3	72.3	81.3	84.3	89.7
208	261	5	61.3	73.3	82.0	84.0	96.5
208	261	25	56.0	72.3	81.7	83.5	93.0
208	261	50	58.0	72.3	82.7	84.3	93.0
208	261	75	58.0	72.3	82.7	84.3	93.0
208	261	95	58.0	72.7	82.7	84.3	93.0
209	274	5	59.3	73.7	83.3	86.0	92.3
209	274	25	58.0	73.7	83.3	84.7	92.3
209	274	50	60.0	73.3	83.0	84.3	92.3
209	274	75	60.3	73.3	83.0	84.0	92.3
209	274	95	60.3	73.3	83.0	84.0	92.3
210	262	5	61.7	74.3	84.3	89.0	92.7
210	262	25	60.3	72.3	83.3	86.3	93.0
210	262	50	58.7	72.3	83.0	86.0	93.0
210	262	75	58.7	72.3	83.0	86.3	93.0
210	262	95	58.7	72.3	83.0	86.3	92.7
211	327	5	57.7	72.3	81.7	86.7	89.7
211	327	25	58.0	71.7	83.7	86.7	91.7
211	327	50	58.0	72.0	83.7	86.7	91.7
211	327	75	58.0	72.0	83.7	86.3	91.0
211	327	95	58.0	72.0	83.7	86.7	91.0
212	312	5	60.0	72.0	82.7	86.0	125.7
212	312	25	60.0	71.3	82.0	85.3	125.7
212	312	50	59.7	71.3	81.7	85.3	124.0
212	312	75	59.7	71.7	81.7	85.0	111.3
212	312	95	59.7	71.7	81.7	85.0	111.3
213	307	5	57.0	71.0	86.7	88.7	92.3
213	307	25	56.3	72.3	83.7	88.7	93.7
213	307	50	57.0	72.3	83.5	88.3	93.7
213	307	75	57.0	72.3	83.5	88.3	93.7
213	307	95	57.0	72.3	83.5	88.3	93.7
214	361	5	61.7	73.0	82.7	86.0	92.0
214	361	25	60.7	73.0	82.7	84.7	88.0
214	361	50	59.3	72.7	82.7	84.7	89.7
214	361	75	60.3	72.5	82.3	84.7	89.7
214	361	95	60.3	72.7	82.3	84.7	89.7
215	323	5	59.0	72.3	82.5	84.0	90.0
215	323	25	60.0	72.7	82.3	84.7	93.7
215	323	50	59.3	73.0	82.3	84.7	100.0
215	323	75	60.0	73.0	82.3	84.7	100.0
215	323	95	59.0	73.0	82.3	84.7	100.0
216	370	5	60.3	72.0	82.3	84.3	98.0
216	370	25	60.3	72.7	83.0	84.7	91.0
216	370	50	60.7	72.7	82.7	84.7	89.3
216	370	75	61.0	72.7	83.0	85.3	89.3
216	370	95	61.0	72.7	83.0	85.3	92.0
217	418	5	61.0	72.0	84.0	84.7	89.3
217	418	25	61.0	72.7	83.3	85.3	90.0
217	418	50	60.3	72.7	84.7	86.3	89.3
217	418	75	60.3	72.7	84.7	86.3	91.0
217	418	95	60.3	72.7	84.7	86.3	91.0
218	393	5	61.3	75.7	84.0	87.0	106.7
218	393	25	59.0	74.0	84.0	88.7	102.7
218	393	50	60.0	73.3	83.7	86.3	102.7
218	393	75	60.0	73.7	84.7	88.0	102.7
218	393	95	60.0	73.3	84.7	88.0	102.7
219	365	5	60.7	74.7	83.0	84.7	91.0
219	365	25	60.7	74.3	83.0	86.0	92.3
219	365	50	60.7	74.0	83.0	86.0	92.3
219	365	75	60.7	74.0	83.0	86.0	92.3
219	365	95	60.7	74.0	83.0	86.0	92.3
220	312	5	57.7	72.3	83.0	85.7	92.0
220	312	25	60.0	72.3	83.0	85.7	92.0
220	312	50	59.7	72.7	83.0	86.0	92.0
220	312	75	59.7	72.7	83.0	85.7	92.0
220	312	95	59.7	72.7	83.0	85.7	92.0
221	291	5	63.3	73.7	84.3	87.7	92.7
221	291	25	60.0	73.7	84.0	86.0	92.7
221	291	50	60.0	73.7	84.0	86.0	92.7
221	291	75	60.0	73.3	84.0	86.0	92.7
221	291	95	60.0	73.7	84.0	86.0	92.7
222	292	5	63.0	73.7	85.3	87.3	94.0
222	292	25	62.7	73.7	84.7	86.3	94.0
222	292	50	61.7	73.7	84.3	86.3	94.0
222	292	75	61.7	73.7	84.3	86.3	94.0
222	292	95	61.7	73.7	84.3	86.3	94.0
223	308	5	62.3	73.3	82.7	84.7	95.7
223	308	25	61.0	73.3	82.7	85.0	95.7
223	308	50	61.0	73.3	82.7	85.0	95.7
223	308	75	61.0	73.7	82.7	85.0	92.3
223	308	95	61.0	73.7	82.7	85.0	92.3
224	358	5	61.7	72.3	84.5	88.3	104.3
224	358	25	60.0	73.7	85.7	87.3	104.3
224	358	50	59.7	73.0	85.3	87.3	104.3
224	358	75	59.7	73.0	85.3	87.3	104.3
224	358	95	59.7	73.0	85.3	87.3	104.3
225	382	5	62.0	74.7	84.0	90.0	106.0
225	382	25	62.0	74.3	84.0	89.7	106.0
225	382	50	61.7	74.0	84.0	89.7	102.7
225	382	75	61.7	74.0	84.0	89.7	102.7
225	382	95	61.7	74.0	84.0	89.7	102.7
226	386	5	63.7	75.0	83.0	91.0	94.0
226	386	25	62.7	73.0	83.0	87.0	92.3
226	386	50	63.3	73.0	83.0	86.3	92.3
226	386	75	63.3	73.0	83.0	87.0	92.3
226	386	95	63.3	73.0	83.0	87.0	92.0
227	373	5	59.0	73.3	84.7	86.0	96.3
227	373	25	59.0	74.3	84.7	89.3	95.7
227	373	50	59.0	74.3	84.7	87.0	95.7
227	373	75	59.0	74.3	84.7	87.0	93.7
227	373	95	59.0	74.3	84.7	87.0	93.7
228	320	5	58.0	74.3	83.7	88.5	96.7
228	320	25	58.0	74.0	84.7	88.5	95.0
228	320	50	58.3	74.0	85.0	89.7	93.0
228	320	75	58.7	73.7	84.7	89.3	93.0
228	320	95	58.7	73.7	84.7	89.0	93.0

Table S3.

Systolic Blood Pressure Centiles for girls

Age (months)	n	Height centile	SBP 5th centile	SBP 50th centile	SBP 90th centile	SBP 95th centile	SBP 99th Centile
180	1,486	5	90.7	106.7	120.0	124.7	134.7
180	1,486	25	90.7	107.7	120.0	124.7	134.0
180	1,486	50	90.7	107.7	121.0	125.3	134.0
180	1,486	75	90.7	107.7	121.0	125.3	134.0
180	1,486	95	90.7	107.7	121.0	125.3	134.0
181	2,310	5	92.0	106.7	120.0	124.5	130.0
181	2,310	25	92.3	107.0	120.3	124.7	131.3
181	2,310	50	92.3	107.0	120.3	124.7	130.7
181	2,310	75	92.3	107.0	120.5	125.0	131.3
181	2,310	95	92.3	107.0	120.3	125.0	131.3
182	2,159	5	91.7	107.7	120.7	123.7	131.0
182	2,159	25	91.7	108.0	120.7	124.0	131.0
182	2,159	50	91.7	108.0	120.7	124.3	131.0
182	2,159	75	92.0	108.0	120.7	124.3	131.3
182	2,159	95	91.7	108.0	120.7	124.3	131.3
183	2,154	5	92.7	106.3	120.0	124.3	133.0
183	2,154	25	92.0	106.7	120.3	124.0	134.0
183	2,154	50	92.3	107.0	120.3	124.3	134.3
183	2,154	75	92.3	107.0	120.7	124.3	134.0
183	2,154	95	92.0	107.0	120.7	124.3	134.0
184	2,084	5	91.7	107.3	120.7	124.0	134.7
184	2,084	25	92.7	107.7	120.3	124.0	134.7
184	2,084	50	92.3	107.3	120.7	124.0	134.7
184	2,084	75	92.7	107.3	121.0	124.3	134.7
184	2,084	95	92.7	107.3	121.0	124.3	134.7
185	1,930	5	93.0	108.0	121.0	124.0	132.7
185	1,930	25	93.0	108.0	121.0	124.7	137.0
185	1,930	50	93.0	108.0	121.0	124.7	135.3
185	1,930	75	93.3	108.0	121.0	124.7	134.7
185	1,930	95	93.3	108.0	121.0	124.7	135.3
186	1,974	5	91.0	108.7	122.0	126.0	134.7
186	1,974	25	91.7	108.7	122.0	127.3	136.3
186	1,974	50	91.7	108.7	122.0	126.7	135.7
186	1,974	75	91.7	108.7	122.0	127.0	135.7
186	1,974	95	91.3	108.7	122.0	127.0	135.0
187	2,056	5	93.3	107.0	120.3	124.3	129.3
187	2,056	25	92.7	108.0	122.0	126.0	133.0
187	2,056	50	93.3	108.0	122.3	125.7	133.0
187	2,056	75	93.0	108.0	122.3	125.7	133.0
187	2,056	95	93.3	108.0	122.0	125.7	133.0
188	2,167	5	93.0	108.0	123.3	125.7	137.0
188	2,167	25	92.7	108.0	122.3	125.3	135.3
188	2,167	50	92.3	108.0	122.3	125.7	135.3
188	2,167	75	92.3	108.0	122.3	125.7	135.3
188	2,167	95	92.3	108.0	122.3	125.7	135.3
189	2,309	5	91.3	108.0	120.7	124.0	135.7
189	2,309	25	92.7	108.0	121.0	125.0	137.7
189	2,309	50	93.3	108.3	121.0	125.0	136.7
189	2,309	75	93.3	108.3	121.0	125.0	136.7
189	2,309	95	93.3	108.3	121.0	125.0	136.7
190	2,351	5	92.0	109.0	122.3	127.7	134.0
190	2,351	25	92.0	108.7	122.0	126.3	133.0
190	2,351	50	91.7	108.7	122.0	125.7	132.7
190	2,351	75	92.0	108.7	122.0	126.3	132.3
190	2,351	95	90.3	108.3	122.0	126.0	132.3
191	2,416	5	92.7	107.3	120.7	125.0	133.0
191	2,416	25	93.7	108.0	121.7	125.3	134.3
191	2,416	50	93.0	107.7	121.7	125.3	134.3
191	2,416	75	93.0	108.0	122.0	125.7	134.3
191	2,416	95	93.0	108.0	122.0	125.7	134.3
192	2,487	5	92.7	108.3	122.3	126.0	133.3
192	2,487	25	92.7	108.3	122.0	126.0	134.7
192	2,487	50	92.0	108.3	122.0	126.0	134.3
192	2,487	75	92.0	108.0	122.0	126.0	134.3
192	2,487	95	92.0	108.0	122.0	126.0	134.3
193	2,155	5	91.7	107.3	120.7	125.3	133.0
193	2,155	25	91.7	108.0	121.3	125.3	133.7
193	2,155	50	91.7	108.0	121.7	125.7	134.3
193	2,155	75	92.0	108.0	121.7	125.7	134.0
193	2,155	95	92.0	108.0	121.7	125.7	134.0
194	2,150	5	92.3	107.7	120.3	124.3	132.7
194	2,150	25	92.3	108.0	120.3	124.7	132.7
194	2,150	50	92.3	108.0	120.7	125.0	133.0
194	2,150	75	92.3	108.0	120.7	125.3	132.7
194	2,150	95	92.3	108.0	120.7	125.3	133.0
195	2,032	5	92.3	109.0	121.3	125.0	133.7
195	2,032	25	91.3	109.0	121.0	125.0	133.7
195	2,032	50	91.3	109.3	121.0	125.0	134.3
195	2,032	75	91.7	109.3	121.0	125.0	134.0
195	2,032	95	91.3	109.3	121.0	125.0	134.0
196	1,942	5	93.0	107.7	121.3	126.0	133.7
196	1,942	25	93.0	108.0	121.7	126.3	134.0
196	1,942	50	93.0	108.0	121.7	126.0	133.5
196	1,942	75	93.0	108.0	121.7	126.0	133.7
196	1,942	95	93.0	108.0	121.7	126.0	134.0
197	1,945	5	93.0	108.0	121.7	126.0	132.3
197	1,945	25	92.7	108.0	122.0	126.0	133.3
197	1,945	50	92.3	108.0	122.3	126.7	134.0
197	1,945	75	92.3	108.0	122.3	126.7	134.0
197	1,945	95	92.3	108.0	122.3	126.7	134.0
198	1,853	5	94.0	107.7	121.7	124.7	132.0
198	1,853	25	94.0	108.3	122.3	126.3	134.7
198	1,853	50	94.0	108.0	122.3	126.3	134.7
198	1,853	75	94.0	108.0	122.3	126.7	134.3
198	1,853	95	94.0	108.0	122.3	126.7	134.3
199	1,925	5	93.0	109.0	123.7	129.3	142.0
199	1,925	25	93.3	109.0	123.0	128.3	142.0
199	1,925	50	93.3	108.7	123.0	128.0	142.0
199	1,925	75	93.3	109.0	123.0	128.3	142.0
199	1,925	95	93.3	108.7	123.0	128.0	142.0
200	2,077	5	92.7	108.3	121.3	125.7	132.7
200	2,077	25	93.7	109.0	122.3	126.7	133.0
200	2,077	50	93.7	109.0	122.3	127.0	133.0
200	2,077	75	93.3	108.7	122.3	127.0	133.0
200	2,077	95	93.3	108.7	122.3	126.7	133.0
201	2,193	5	94.3	109.0	122.7	126.7	139.5
201	2,193	25	93.3	109.0	122.3	126.7	136.7
201	2,193	50	93.3	109.0	122.3	126.3	136.7
201	2,193	75	93.3	109.0	122.0	126.3	136.7
201	2,193	95	93.3	109.0	122.0	126.3	136.7
202	2,344	5	92.7	108.3	122.0	126.0	133.7
202	2,344	25	92.3	108.7	122.3	126.7	134.7
202	2,344	50	92.3	108.7	122.3	126.7	134.7
202	2,344	75	92.3	108.3	122.3	126.7	134.3
202	2,344	95	92.3	108.7	122.3	126.7	134.3
203	2,176	5	93.0	108.7	122.0	126.0	133.3
203	2,176	25	93.0	108.3	122.0	126.0	133.0
203	2,176	50	92.7	108.3	122.0	126.0	134.0
203	2,176	75	92.7	108.3	122.0	126.3	134.0
203	2,176	95	92.7	108.3	122.0	126.0	134.0
204	2,331	5	90.3	107.7	121.3	125.7	134.0
204	2,331	25	91.3	108.0	121.0	125.7	134.0
204	2,331	50	91.3	108.0	121.3	126.3	135.3
204	2,331	75	91.7	108.0	121.3	126.3	135.3
204	2,331	95	91.7	108.0	121.3	126.3	136.0
205	1,949	5	93.3	109.3	123.0	127.3	137.0
205	1,949	25	93.7	108.0	122.7	127.3	137.0
205	1,949	50	93.7	108.0	122.7	127.3	136.7
205	1,949	75	93.7	108.0	122.7	127.0	136.7
205	1,949	95	93.7	108.0	122.7	127.0	136.7
206	1,916	5	93.0	107.3	121.0	125.7	136.0
206	1,916	25	92.7	107.7	121.7	124.7	135.3
206	1,916	50	92.7	107.7	122.0	125.7	135.7
206	1,916	75	93.0	107.7	122.0	125.7	135.7
206	1,916	95	93.0	107.7	122.0	125.7	135.7
207	1,773	5	92.0	108.7	121.3	125.7	135.7
207	1,773	25	92.0	109.0	122.0	126.0	135.7
207	1,773	50	92.0	108.7	122.0	126.0	135.0
207	1,773	75	92.0	108.7	122.0	126.0	135.0
207	1,773	95	92.0	108.7	122.0	126.0	135.0
208	1,792	5	91.3	109.0	121.3	125.3	134.0
208	1,792	25	92.3	109.3	123.0	126.7	135.0
208	1,792	50	92.3	109.3	123.0	126.3	135.0
208	1,792	75	92.3	109.0	123.0	126.3	135.0
208	1,792	95	92.3	109.0	123.0	126.3	135.0
209	1,683	5	92.3	107.3	121.3	127.0	131.3
209	1,683	25	93.0	107.3	121.7	127.0	132.7
209	1,683	50	93.0	107.7	121.7	127.0	133.3
209	1,683	75	93.0	107.3	121.7	127.0	133.3
209	1,683	95	93.3	107.5	121.7	127.0	133.3
210	1,686	5	93.7	108.7	122.0	126.7	133.5
210	1,686	25	92.3	108.3	121.7	126.7	132.3
210	1,686	50	92.3	108.7	122.0	127.0	133.3
210	1,686	75	92.3	108.7	122.0	127.0	133.3
210	1,686	95	92.3	108.7	122.0	127.0	133.3
211	1,923	5	92.0	108.0	122.0	126.7	136.3
211	1,923	25	92.0	108.0	122.0	126.7	135.0
211	1,923	50	92.3	108.3	122.3	126.7	135.3
211	1,923	75	91.7	108.3	122.0	126.7	135.3
211	1,923	95	91.7	108.3	122.0	126.7	135.3
212	1,991	5	92.7	109.3	122.7	126.0	132.7
212	1,991	25	92.3	108.7	122.7	126.0	134.0
212	1,991	50	92.7	108.7	123.0	126.0	134.7
212	1,991	75	92.7	109.0	123.0	126.0	134.0
212	1,991	95	92.7	109.0	123.0	126.0	134.0
213	2,159	5	93.0	108.7	123.0	128.3	135.0
213	2,159	25	92.7	108.7	122.7	127.0	134.7
213	2,159	50	92.3	108.3	122.3	127.0	134.7
213	2,159	75	92.3	108.3	122.3	127.0	134.7
213	2,159	95	92.3	108.3	122.3	127.0	134.7
214	2,224	5	94.3	108.7	120.7	125.7	133.0
214	2,224	25	93.7	109.0	121.3	125.7	133.7
214	2,224	50	93.5	109.0	121.3	125.7	134.3
214	2,224	75	93.3	109.0	121.3	125.7	134.3
214	2,224	95	93.3	109.0	121.3	125.7	133.7
215	2,117	5	93.3	108.0	122.0	127.0	138.7
215	2,117	25	93.3	108.0	122.0	127.3	139.0
215	2,117	50	93.3	108.3	122.0	127.0	138.7
215	2,117	75	93.0	108.3	122.0	127.0	138.7
215	2,117	95	93.0	108.3	122.0	127.0	138.7
216	2,481	5	93.3	109.3	122.7	126.7	137.3
216	2,481	25	92.7	109.0	122.7	126.3	136.7
216	2,481	50	92.7	108.7	122.3	126.3	136.7
216	2,481	75	92.7	108.7	122.7	126.3	136.7
216	2,481	95	92.7	108.7	122.7	126.3	136.7
217	2,421	5	92.7	109.7	123.0	126.3	137.7
217	2,421	25	93.0	109.7	123.0	126.7	137.3
217	2,421	50	93.3	109.3	123.0	127.0	137.3
217	2,421	75	93.0	109.3	123.0	127.0	137.3
217	2,421	95	93.0	109.3	123.0	127.0	137.3
218	2,364	5	92.0	109.7	123.0	128.0	136.0
218	2,364	25	92.7	109.3	123.3	127.3	136.3
218	2,364	50	92.7	109.5	123.3	127.3	136.0
218	2,364	75	92.7	109.7	123.0	127.3	136.0
218	2,364	95	92.7	109.7	123.3	127.3	136.0
219	2,163	5	93.3	109.3	122.3	126.0	139.3
219	2,163	25	93.0	109.5	122.3	126.3	139.3
219	2,163	50	93.0	109.3	122.3	126.3	139.3
219	2,163	75	93.0	109.3	122.3	126.7	139.3
219	2,163	95	93.0	109.3	122.3	126.7	139.3
220	2,090	5	92.3	109.0	121.0	125.0	139.0
220	2,090	25	92.0	109.0	122.3	126.0	138.3
220	2,090	50	92.3	109.0	122.3	126.3	137.3
220	2,090	75	92.7	109.0	122.3	126.3	137.3
220	2,090	95	92.7	109.0	122.3	126.0	137.3
221	2,011	5	93.3	109.3	122.7	127.3	134.3
221	2,011	25	93.3	109.0	122.3	127.3	134.7
221	2,011	50	93.0	108.7	122.3	127.3	134.7
221	2,011	75	93.0	108.7	122.3	127.3	134.7
221	2,011	95	93.0	108.7	122.3	127.0	134.7
222	2,031	5	93.5	109.3	122.3	127.3	137.5
222	2,031	25	93.7	109.7	123.3	129.0	142.3
222	2,031	50	93.7	109.7	123.0	128.5	140.3
222	2,031	75	93.7	109.7	123.3	128.3	140.3
222	2,031	95	93.7	109.7	123.3	128.3	140.3
223	2,056	5	92.7	110.7	123.0	128.0	136.0
223	2,056	25	92.0	109.7	123.0	127.7	136.3
223	2,056	50	92.0	109.7	123.0	127.7	136.3
223	2,056	75	91.7	109.7	122.7	127.7	136.3
223	2,056	95	91.7	109.7	122.7	127.7	136.3
224	2,308	5	93.3	109.7	123.3	128.7	139.3
224	2,308	25	93.3	109.7	123.3	128.0	135.7
224	2,308	50	92.7	109.7	123.3	128.0	135.7
224	2,308	75	92.7	109.7	123.3	128.0	135.7
224	2,308	95	93.0	109.7	123.3	128.0	135.7
225	2,513	5	92.3	109.3	123.3	128.0	140.7
225	2,513	25	92.3	109.3	123.7	127.7	138.0
225	2,513	50	92.3	109.3	123.7	127.7	139.3
225	2,513	75	92.3	109.3	124.0	127.7	139.3
225	2,513	95	92.7	109.3	124.0	127.7	139.3
226	2,578	5	93.3	109.7	123.3	127.3	138.3
226	2,578	25	94.0	109.7	123.3	127.3	137.7
226	2,578	50	94.0	110.0	123.7	127.7	138.3
226	2,578	75	94.0	110.0	123.3	127.7	138.3
226	2,578	95	94.0	110.0	123.3	127.7	138.3
227	2,626	5	93.0	109.0	123.0	127.3	136.7
227	2,626	25	93.0	108.7	122.7	127.3	135.7
227	2,626	50	92.7	108.7	122.7	127.3	135.5
227	2,626	75	92.7	108.7	122.7	127.3	135.5
227	2,626	95	92.7	108.7	122.7	127.3	135.5
228	2,271	5	94.0	109.0	122.3	126.3	139.0
228	2,271	25	94.0	109.3	122.3	127.0	137.0
228	2,271	50	94.0	109.3	122.5	127.0	137.0
228	2,271	75	94.0	109.3	122.5	127.0	137.7
228	2,271	95	93.7	109.3	122.5	127.0	137.7

Ethics

The study was ethically approved by the Institute’s Ethical Committee, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (PGI/IEC/2021/001139).

Results

We analyzed the data of 15,936 boys and 1,04,132 girls. The mean age of both girls and boys was 17.07 years each. The maximum number of individuals were from Uttar Pradesh (n = 23,470), followed by Madhya Pradesh (n = 12588) and Bihar (n = 10315). Lakshadweep (n = 130), followed by Chandigarh (n = 132), and Dadra and Nagar Haveli (n = 164) had the minimum number of individuals. The majority of the survey participants were from rural areas (73.45%). The flow chart for the selection of the participants is shown in Figure 1. In total, we used data of 90.6% girls and 87.5% boys in the age group of 15–19 years.

Figure 1.

Study flow chart

Nomogram for BP of boys and girls is shown in [Figures 2 and 3]. Only 50^th, 90^th, and 95^th systolic and diastolic BP centiles were included as they provided information on the median values and cut-off values for hypertension and elevated BP. The BP (both systolic and diastolic) between the 90^th and 95^th centile lines represents elevated BP and the BP of more than 95^th centile lines represents stage 1 hypertension. Furthermore, values of more than 99^th centile representing stage 2 hypertension can be found in the supplementary tables. Supplementary tables (S1–S4) provide complete percentile values of systolic and diastolic BP according to gender, age (in months), and height-for-age centiles.

Figure 2.

Nomogram of blood pressure for boys of age 15–19 years at the 50^th centile for height

Figure 3.

Nomogram of blood pressure for girls of age 15–19 years at the 50^th centile for height

Both systolic and diastolic BP increased with age and height centiles. The BP was higher in boys than in girls. An average annual increase in the systolic and diastolic BP was 2.52 and 1.20 mmHg in boys; and 0.50 and 0.46 mmHg in girls, respectively, when adjusted for height centiles (Supplementary Tables S1–S4).

Discussion

In the current study, we present the nomogram of BP among adolescent boys and girls between ages 15 and 19 years. Hypertension among adolescents is a prevalent but often undiagnosed condition. The categorization of BP into elevated BP (BP >90^th centile) and hypertension (BP >95^th centile) also helps to identify the individual children based on their risk profile.[2] The normative values of BP depend on the age, sex, and height centile of the individual.

While there are other studies from India, most of them are on smaller samples that are not nationally represented.[7,13,14] A study by Raj M, et al.[7] conducted among non-overweight school-going children, the estimated cut-off BPs to be 130/86 and 133/88 among boys of ages 15 and 16 years at the 50^th height centile for age; and 133/89 each among girls of ages 15 and 16 years at the 50^th height centile for age. For the same age groups in our study, the cut-offs were 124/82 and 126/84 for boys of ages 15 and 16 years; and 126/84 each for girls of ages 15 and 16 years. The higher values of BPs in the study by Raj M, et al.[7] can be because the BP measurements were taken in school, while in the NFHS-4 survey, the measurements were taken in home settings.

Compared with the latest guidelines by the American Academy of Pediatrics (AAP), we see that among boys, the 90^th centile for systolic BP is less than 130 mmHg up to about 210 months (18^th year of life), while the 95^th centile is less than 140 mmHg in all the age groups and all height centiles. Among girls, the systolic BP is always less than the cut-offs prescribed for pre-hypertension and hypertension. Hence, using the recent AAP cut-offs, pre-hypertension and hypertension would be underdiagnosed using the systolic BP criteria. However, for diastolic BP among both boys and girls, while the 90^th centile is more than 80 mmHg, the 95^th centile is less than 90 mmHg in all ages. Hence, hypertension would be underdiagnosed using the diastolic criteria. One of the aims of diagnosing pre-hypertension is to diagnose the underlying diseases, and if they are not present, to start early in life, the necessary lifestyle changes. For these reasons, a lower cut-off should be more appropriate.

The strength of this study is that we used a nationally representative sample from a large survey in which BP was measured using a standard apparatus and standard method. The current BP nomogram, thus, is applicable in Indian settings.

There are a few limitations to this study. First, since there are no data on co-morbidity, adolescents with morbidities such as chronic kidney disease, sleep disorders, endocrine abnormalities, or prematurely born adolescents would also be included. Second, obesity was not considered for the nomogram. Previous research has shown that an increase in BMI for age among adolescents leads to an increase in systolic and diastolic BP.[15,16,17] Considering children in the normal range of BMI-for-age will lead to a lower cut-off for both systolic and diastolic BPs. In our dataset, there were 513 (3.2%) boys and 2,801 (2.7%) girls who were obese, with BMI-for-age more than 3 SD. Due to these two factors, the normative values of BP might have been overestimated.

Conclusion and Recommendations

The current BP nomogram can be generalized to the Indian population. Further research is required for the diagnostic performance of this nomogram for the diagnosis of adolescent hypertension.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.