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Observational Study
. 2020 May 5;10(5):e033618.
doi: 10.1136/bmjopen-2019-033618.

Cross-sectional centiles of blood pressure by age and sex: a four-hospital database retrospective observational analysis

David Wong  1   2 , Stephen Gerry  3 , Farah Shamout  4 , David A Clifton  4 , Marco A F Pimentel  4 , Peter J Watkinson  5
Affiliations
Observational Study

Cross-sectional centiles of blood pressure by age and sex: a four-hospital database retrospective observational analysis

David Wong et al. BMJ Open. .

Abstract

Objectives: National guidelines for identifying physiological deterioration and sepsis in hospitals depend on thresholds for blood pressure that do not account for age or sex. In populations outside hospital, differences in blood pressure are known to occur with both variables. Whether these differences remain in the hospitalised population is unknown. This database analysis study aims to generate representative centiles to quantify variations in blood pressure by age and sex in hospitalised patients.

Design: Retrospective cross-sectional observational database analysis.

Setting: Four near-sea-level hospitals between April 2015 and April 2017 PARTICIPANTS: 75 342 adult patients who were admitted to the hospitals and had at least one set of documented vital sign observations within 24 hours before discharge were eligible for inclusion. Patients were excluded if they died in hospital, had no vital signs 24 hours prior to discharge, were readmitted within 7 days of discharge, had missing age or sex or had no blood pressure recorded.

Results: Systolic blood pressure (SBP) for hospitalised patients increases with age for both sexes. Median SBP increases from 122 (CI: 121.1 to 122.1) mm Hg to 132 (CI: 130.9 to 132.2) mm Hg in men, and 114 (CI: 113.1 to 114.4) mm Hg to 135 (CI: 134.5 to 136.2) mm Hg in women, between the ages of 20 and 90 years. Diastolic blood pressure peaked around 50 years for men 76 (CI: 75.5 to 75.9) mm Hg and women 69 (CI: 69.0 to 69.4) mm Hg. The blood pressure criterion for sepsis, systolic <100 mm Hg, was met by 2.3% of younger (20-30 years) men and 3.5% of older men (81-90 years). In comparison, the criterion was met by 9.7% of younger women and 2.6% of older women.

Conclusion: We have quantified variations in blood pressure by age and sex in hospitalised patients that have implications for recognition of deterioration. Nearly 10% of younger women met the blood pressure criterion for sepsis at hospital discharge.

Keywords: ageing; blood pressure; hospitals; physiology.

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Conflict of interest statement

Competing interests: DW and PJW co-developed the SEND e-Obs system (for which Sensyne Health has purchased sole license) from which the study database was collected. The company has a research agreement with the University of Oxford and royalty agreements with Oxford University Hospitals NHS Trust and the University of Oxford. DAC is Research Director of Sensyne Health. PJW is employed part-time and holds shares in Sensyne Health. DW undertakes consultancy for Sensyne Health.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials diagram showing analysis inclusion criteria.
Figure 2
Figure 2
1st, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 99th centiles of (A) systolic, (B) diastolic and (C) pulse blood pressure for men and women between the ages of 20 and 90 years. Dashed lines in (A) denote SBP = (90, 100, 110) mm Hg.
Figure 3
Figure 3
Medians of systolic, diastolic and pulse blood pressure for all men and women between the ages of 20 and 90 (dashed lines) and the subgroup excluding patients with ICD codes for hypertension (solid lines).
Figure 4
Figure 4
1st, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 99th Systolic blood pressure centiles for emergency and elective subgroups.
See this image and copyright information in PMC

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