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The purpose of this study were to: (a) examine for possible ethnicity-related and gender-related differences in blood pressure (BP) in Mexican American and non-Hispanic White schoolchildren; (b) compare auscultatory and oscillometric BP levels; and (c) establish auscultatory BP standards using the width of the BP cuff based on the circumference of the arm in schoolchildren in K-12.Participants were 6259 schoolchildren in kindergarten through 12th grade in the San Antonio, Texas, area. Auscultatory and oscillometric BP readings were obtained in random sequence, using BP cuff width 40% to 50% of the circumference of the upper arm. Averages of 3 readings were used for statistical analyses.Auscultatory systolic pressures (SPs) in preadolescent Mexican American boys and girls were higher (1 to 3 mm Hg) auscultatory (SP) than in their White counterparts, but the difference was clinically not important. Diastolic pressures (DP) showed no important differences. Auscultatory SPs in 13- to 18-year-old boys of both ethnic groups were significantly (P.05) higher (3 to 12 mm Hg) than they were for girls, with no ethnic differences. Oscillometric SP was higher than auscultatory SP in children of all ages studied. Oscillometric (DP) was slightly lower (0 to 5 mm Hg) than was auscultatory K4 and higher (4 to 5 mm Hg) than was auscultatory K5 DP.No important ethnicity-related difference was found for auscultatory BP, but significant gender-related differences (boys greater than girls) were found in SP in subjects ages 13 to 18 years. Differences in BP readings by oscillometric and auscultatory methods do not allow interchange of readings. This study provides, for the first time, auscultatory BP standards using BP cuff width 40% to 50% of the arm circumference.

Comparing blood pressure (BP) obtained in the arm with that obtained in the thigh or calf is important in the diagnosis of aortic coarctation. However, normative mean and range of differences in BP between the arm and lower extremity sites are not available for normal children. It is also not known how accurately the differences in BP between the arm and the lower extremity sites predict the pulsed Doppler estimation of systolic pressure (SP) gradient across an aortic coarctation. To resolve these questions, the authors obtained two BP measurements by an oscillometric (Dinamap) method in the arm, thigh, and calf in 74 healthy children aged 4 to 16 years. Oscillometric BP was also obtained in 21 children aged 3 to 17 years with preoperative or postoperative aortic coarctation and BP gradients were compared with that estimated by the pulsed Doppler method. Overall, SP was higher in the thigh and calf than in the arm. The gradients in SP expressed as arm SP minus calf SP [S(A - C)] and arm SP minus thigh SP [S(A - T)] were significantly greater in children 4 through 8 years old than in those 9 to 16 years old. The S(A - C) was –9.3 (±7.4 SD) mm Hg in the 4- through 8-year group and –5.0 (±6.9 SD) mm Hg in the 9- to 16-year group. The S(A - T) was –7.1 (±6.8 SD) mm Hg in the 4- through 8-year group and –2.4 (±7.7 SD) mm Hg in the 9- to 16-year group. Diastolic and mean arterial BP levels were lower in the calf (9 and 1 mm Hg, respectively) and the thigh (11 and 4 mm Hg, respectively) than in the arm. The S(A - C) in all patients with preoperative aortic coarctation and those with significant residual coarctation was greater than the mean + 2 SD for healthy children. The S(A - C) and S(A - T) values in patients with preoperative or postoperative coarctation correlated well with the pulsed Doppler-based estimates of the gradient (r = .908 and .936, respectively). This correlation and the comparison of known cases of coarctation with the normative gradients suggest (1) if the Dinamap SP in the calf or thigh is lower than that in the arm, the presence of aortic coarctation is suspicious, and (2) if the S(A - C) and/or S(A - T) is greater than the mean + 2 SD for normal children, the diagnosis of aortic coarctation is likely. It appears that, in addition to testing for a delayed pulse in the leg, properly obtaining oscillometric values for systolic BP in the arm and the calf or thigh is important in the diagnosis, management, and postoperative evaluation of aortic coarctation.