pedbp : Pediatric Blood Pressure

An R package for estimating expected blood pressure of children and adolescences

Objective

Provide a method for translating pediatric blood pressures, dependent on age, sex, and height (if known), to percentiles.

Method

Blood pressure percentiles are based on Gaussian distributions defined by published values for the mean and standard deviation, or derived mean and standard deviations based on published percentiles.

How to Install

Install the developmental version:

remotes::install_github("dewittpe/pedbp", dependencies = TRUE)

Tools

Blood Pressure Distribution and Quantile Functions

Inputs for these functions are:

age: in months, required
male: indicator for for sex; 0 = female, 1 = male, required
height: in centimeters, if known
sbp,dbp: systolic and diastolic blood pressure in mmHg, if known

d <- read.csv(system.file("example_data", "for_batch.csv", package = "pedbp"))
d

##           pid age_months male height..cm. sbp..mmHg. dbp..mmHg.
## 1   patient_A         96    1          NA        102         58
## 2   patient_B        144    0         153        113         NA
## 3   patient_C          4    0          62         82         43
## 4 patient_D_1         41    1          NA         96         62
## 5 patient_D_2         41    1         101         96         62

# distribution function
p_bp(  q_sbp  = d$sbp..mmHg.
     , q_dbp  = d$dbp..mmHg.
     , age    = d$age_months
     , male   = d$male
     , height = d$height..cm.
     )

## $sbp_percentile
## [1] 0.5533069 0.7680548 0.2622697 0.6195685 0.6101926
## 
## $dbp_percentile
## [1] 0.4120704        NA 0.1356661 0.8028518 0.9011263

# quantile function
q_bp(  p_sbp = 0.50
     , p_dbp = 0.40
     , age   = 96
     , male  = 1)

## $sbp
## [1] 100.7
## 
## $dbp
## [1] 57.74789

Plots show where an observed blood pressure is on the distribution curve

bp_cdf(  sbp = 105
       , dbp = 59
       , age   = 96
       , male  = 1)

More examples and details for the blood pressure distribution functions, along with additional features such as CDC growth charts, can be found in the package vignette.

vignette("bp-distributions", package = "pedbp")

Shiny Application

An interactive Shiny application is also available. After installing the pedbp package and the suggested packages, you can run the app locally via

shiny::runApp(system.file("shinyapps", "pedbp", package = "pedbp"))

References

Expert Panel On Integrated Guidelines For Cardiovascular Health and Risk Reduction in Children and Adolescents. 2011. “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report.” Pediatrics 128 (Supplement_5): S213–56. https://doi.org/10.1542/peds.2009-2107C.
Gemelli, M, R Manganaro, C Mami, and F De Luca. 1990. “Longitudinal Study of Blood Pressure During the 1st Year of Life.” European Journal of Pediatrics 149 (5): 318–20.
Lo, Joan C, Alan Sinaiko, Malini Chandra, Matthew F Daley, Louise C Greenspan, Emily D Parker, Elyse O Kharbanda, et.al. 2013. “Prehypertension and Hypertension in Community-Based Pediatric Practice.” Pediatrics 131 (2): e415–24.
Martin, Blake, Peter E. DeWitt, Scout HF, SK Parker, and Tellen D. Bennett. 2022. “Machine Learning Approach to Predicting Absence of Serious Bacterial Infection at PICU Admission.” Hospital Pediatrics.