Data from the

NATIONAL HEALTH SURVEY

Series 11

Number 163

Blood Pressure of Youths

12-17 Years

United States

Systolic and diastolic blood pressure measurements of youths 12-17

years of age in the United States from the Health Examination Survey of 1966-1970, by age, sex, race, geographic region, urban or

rural area of residence, family income, and education of head of

household.

DHEW Publication No. (H RA) 77-1645

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Resources Administration

National Center for Health Statistics

Rockville, Md. March 1977
Library of Congress Cataloging in Publication Data

Roberts, Jean

Blood pressure of youths 12-17 years, United States.

(Vital and health statistics: Series 11, Data from the National Health Survey; no. 163)

(DHEW publication; no. (HRA) 77-1645)

“Systolic and diastolic blood pressure measurements of youths 12-17 years of age in the

United States from the health examination survey of 1966-1970, by age, race, geographic

region, urban-rural, family income, and parent education. ”

Includes bibliographical references.

1. Youth–Health and hygiene-United States–Statistics. 2. Blood pressure–United

States–Statistics. 3. Health surveys–United States. I. Maurer, Kurt, joint author. II. Title.

III. Series: United States. National Center for Health Statistics. Vital and health statistics:

Series 11, Data from the National Health Survey, Data from the health examination survey;

no. 163. IV. Series: United States. Dept. of Health, Education, and Welfare. DHEW publication; no. (HRA) 77-1645.

RA407.3.A347 no. 163 [RA564.5] 312’.0973s [312’.6]

ISBN 0-8406 -0074-7 76-17117

FoI’sale by the Superintendent of Documents, U.S. Government printiig office

Washington, D,C, 20402

Stock No. 017-022-00545-0
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Directorfor AnaZysis

GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systems

ANDERS S. LUNDE, Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph.D., Associate Director for Statistical Research

ALICE HAYWOOD, Information Off{cer

DIVISION OF HEALTH EXAMINATION STATISTICS

ARTHUR J, McDOWELL, Director

JEAN-PIERRE HABICHT, M.D., Ph.D., Special Assistant to Director

PETER V. V. HAMILL, M.D., Medical Adviser

JEAN ROBERTS, C?ziefi Medical Statistics &-anch

ROBERT S. MURPHY, Chiej Survey Pkzrming and Development i%ursch

COOPERATION OF THE BUREAU OF THE CENSUS

In accordance with specifications established by the Nationaf Center for Health Statistics, the

Bureau of the Census, under a contractual agreement, participated in the design and selection of

the sample, and carried out the first stage of the field interviewing and certain parts of the

statistical processing.

Vital and Health Statistics-Series 11-No.l 63

DHEW Publication No. (HRA) 77-1645

Library of Congress Catalog Card Number 76-17117
FOREWORD

The National Center for Health Statistics

collects and disseminates data on health through

a number of specific programs focused on different aspects of health. All of these programs share

a deep concern with the quality and reliability of

the data. The Health Examination Statistics Division has from its inception been constantly concerned with the problems of sampling and nonsampling (or measurement) error. We have made

great efforts to minimize, to measure, and to

report to the reader the nature and extent of these

problems.

The blood pressure data included in the present report present a special problem in this

regard. Several years ago when these data were

first tabulated for what was assumed would be

presentation in this report series in the usual

manner, it was apparent that the data did not fit

the expected continuum. The expectation was

based in part on general knowledge of the literature but more particularly on the data obtained

in the first and second cycles (or programs) of

our Health Examination Surveys. The data for

the ages 12-17 years were at an unexpectedly

high level producing discontinuities in the curve

with a sharp increase between ages 11 and 12

years and a correspondingly sharp decrease after

age 17.

The obvious suspicion was that some systematic measurement error had flawed the data for

the 12.17 year old youths. As time permitted,

these data were examined in many detailed ways

in an attempt to better understand what might

account for the observed picture. In an appendix

to this report, the authors present some of these

results. It appears from these results that the

data had a very high degree of internal consistency. Separate subgroups by age, sex, race, or

location, for example, showed a consistent picture.

(i.e.,

Such factors as positioning of the subject

sitting or recumbent), time of day of examination,

measuring

or smoking

possible systematic differences in

techniques by different examiners,

habits could not have been responsible for the unexpectedly high general level of

the readings.

Meanwhile data were becoming available

from the first Health and Nutrition Examination

Survey (HANES) in which a blood pressure measurement was included for the entire age range.

This survey, however, had been addressed to the

full age range of 1 through 74 years and had had

nutrition and unmet health needs as special

focuses. As a result, the data available from it

with respect to youths’ blood pressures are much

less extensive. Only one measurement of blood

pressure was made, contrasted with three in the

12-17 year old Health Examination Survey program. Even more important, the size of the

population sample in these age groups was less

than one-third as large as in the youth program.

As a result, the HANES data on blood pressure

cannot be looked at in detail with respect to such

variables as single year of age, sex, race, region,

and income and education of parent+ The HANES

data do, however, provide a comparison with

respect to overall mean blood pressure values.

These data, soon to appear in a separate report

in this series, indicate that blood pressures in the

12-17 year age range are lower than those in the

immediately succeeding years and lower than

those recorded in the third cycle program of the

Health Examination Survey.

The most likely explanation for the difference

(i.e., between the levels of blood pressure recorded in the third cycle program and the lower

levels expected from other evidence) seemed to

be one associated with the process of measurement. In this connection, it should be noted that

the measurements were made by relatively few

examiners. In the first blood pressure report

from the first Health Examination Survey (Vii!d
and Health Statistics, Series 11, No. 4), a discussion of examiner variability included the following statement: “For studies in which only a

few observers measure the blood pressure, such

risks” (examiner bias) “are obviously present.”

Unfortunately, the reduced level of resources

available during theexamination survey of 12-17

year old youths resulted in only two observers

making almost all of the blood pressure measurements. Also unfortunately, failure to require recording of the size of the cuff used intheindividual measurements precluded the possibility

of our reconstructing from the data relationships

between the percentage of total arm area covered

and recorded pressure.

Thus, the special problem presented by these

blood pressure data was the following dilemma.

Publication of the observed measurements might

mislead users of the data if the general level in

the 12-17 population was actually substantially

lower than found in this survey. On the other hand,

failure to make the data available to users would

deprive them of the opportunity to examine for

themselves a large set of blood pressure measurements made in a standardized manner on a

representative sample of the 12-17 year old

segment of the U.S. population. It has been decided

to present the data included in the present report

because it is believed they represent carefully

and uniformly made recordings which can provide useful comparisons of internal relationships

within the data themselves. The reader is cau.

tioned against making any use of the absolute

levels of blood pressure shown without careful

regard to the above considerations and the cautions included in the report. It is well to remember

the conclusion stated nearly 20 years ago by B#e

and his colleagues in reporting their study of

blood pressures in Bergen, Norway that one shall

not attach too much importance to absolute figures

and that it may be dangerous to compare investigations. a It is believed that the data permit useful internal comparisons by age, race, sex, and

other subgroups and that the value of and need for

further study of the important area of hypertension outweigh the limitations we acknowledge.

Arthur J. McDowell

Director, Division of Health

Examination Statistics

aB+e, ‘J., Humerfek, S., and Wedervang, F.: The blood pressure in a population; blood pressure readings and height and weight

determinations in the adult population of the C@ of Bergen. Acts. med Scadinav. Supplement 321. Bergen. 1957.

iv
CONTENTS

Foretvord ...........................................................................................................................................................

Introduction .................................................................................................................................. ....................

Blood Pressure Measurements ............................................................................................................................

Findings .............................................................................................................................................................

&e and Sex............................................................................................................................. .....................

Race .............................................................................................................................................................

Geographic Re~on .......................................................................................................................................

Urban or Rural Area of Residence ................................................................................................................

Family Income ................................................................................................................................ .............

Education of Head of Household ..................................................................o......................e......................

Comparison With Previous Herdth Examination Survey Fbdkgs ..................................................................

Comparison With Other Studies ....................................................................................................................

Summary ...........................................................................................................................................................

References ................................................................................................................................ .........................

I&it of Detailed Tables ................................................................................................................................... ....

Appendixes

I. Sources of Variation in the Measurement of Blood Pressure

II. Statisticrd Notes

..............................................................

.................................................................................................................................

111. Demographic and Socioeconomic Terns ......................................................................................o.....

LIST OF FIGURES

1. Mean systolic and diastolic blood pressure of youths by age and sex: United States, 1966-1 970 .................

2.

3.

4,

5.

6.

7.

hlean systofic and diastolic blood pressure of white and Negro youths by age and sex: United States,

1966.1970 ........................................................................................................................o........................

hfean systolic and diastolic blood pressure of msdes and females 6-24 years of age: United States, 1960-

1970 ................................................................................................................................. .........................

hiean systolic and diastolic blood pressure of white males and females 6-24 years of age: United States,

1960-1970 ......................................................................................................................................... ........

hican systolic and diastofic blood pressure of Ne~o males and females 6-24 years of age: United States,

1960.1970 .................................................................................................................................................

hfean systolic and diastofic blood pressure of white and Negro males 6-24 years of age: United States,

1960-1970 .................................................................................................................................................

Mean systolic and diastolic blood pressure of white and Negro femafes 6-24 years of a~e: United States,

1960.1970 .................................................................................................................................................

8. Mean systolic and diastolic blood pressure of boys by age from studies of Johnson et al (Tecumseh),

Londe (St. Louis), McCammon (Denver), Moss, and nationid estimates for U.S. boys from the 1963-1970

Health Examination Survey .......................................................................................................................

... m

1

2

3

3

4

5

6

6

6

1;

14

16

17

:

61

3

5

8

9

10

10

10

13

v
9. Mean systolic and diastolic blood pressure of girls by age from studies of Johnson et al (Tecumseh),

Londe (St. Louis), McCammon (Denver), Moss, and national estimates for U.S. girls from the 1963-1970

Health Examination Survey ....................................................................................................................... 14

LIST OF TEXT TABLES

A. Systolic and diastolic median blood pressures taken in the prone position of youths 12-17 years by race

and family income: United States, 1966-1970 ........................................................................................... 11

B. Systolic and diastolic median blood pressures taken in the prone position of youths 12-17 years by race

and education of parent: IJruted States, 1966.1970 ................................................................................... 11

C. Design chwacteristics of selected studies of blood pressure among children and youths ............................... 13

SYMBOLS

Data not available---------------------------------------- ---

Category not applicable ------------------------------- . . .

Quantity zero---------------------------------------------- -

Quantity more than Obut less than 0.05 ----- 0.0

Figure does not meet standards of

reliability or precision------------------------------ *
BLOOD PRESSURE OF YOUTHS 12-17 YEARS

Jean Roberts and Kurt Maurer, Division of Health Examination Statistics

INTRODUCTION

This report contains data on blood pressure

of youths 12.17 years of age in the noninstitutionalized population of the United States, as estimated

from direct examination findings from the Health

Examination Survey of 1966-70 among a national

probability sample representative of the 22.7

million youths in that segment of the population.

Findings are analyzed with respect to age, sex,

race, geographic region, area of residence, annual

family income, and educational level of the head

of the household.

In using these national estimates of blood

pressure levels for the ages 12-17 years, the

reader should keep in mind that these data show

a marked degree of internal consistency but are

unexpectedly high in comparison with previous

national survey findings and with those from

the first Health and Nutrition Examination Survey

of 1971-1974 (soon available in a separate report)

for reasons apparently attributable primarily to

ones associated with the examiners who used the

1951 American Heart Association criteria, as

described in the findings and in appendix I.

The Health Examination Survey is one of the

major programs of the National Center for Health

Statistics which was authorized through the National Health Survey Act of 1956 by the 84th Congress as a continuing Public Health Service

responsibility to determine the health status of

the population. 1

The principal health survey programs in the

National Center for Health Statistics which carry

out the intent of the National Health Survey Act

are those of the Divisions of Health Examination

Statistics, Health Interview Statistics, Health

Manpower and Facilities Statistics, and Health

Resources Utilization Statistics. The Health Interview Survey, which collects health information

from samples of people by household interview,

primarily studies the impact of known illness and

disability on the lives of people. The Health Manpower and Facilities program obtains information

through surveys of hospitals, nursing homes, and

other resident institutions and the entire range of

personnel in the health occupations. The Health

Resources Utilization surveys obtain information

on the extent of health facility and service utilization. In the Health Examination Survey data

are collected through direct physical examinations, tests, and measurements performed on

carefully selected nationwide probability samples

of the population. This latter system, in addition

to providing the most efficient way of obtaining

actual diagnostic data on the prevalence of specified medically defined illness, is the only one of

the survey methods used to secure information on

unrecognized or undiagnosed conditions as well as

a variety of physical, physiological, and psychological measures within the population. Medical

history, demographic, and socioeconomic data

are also obtained on the sample population under

study, making possible the interrelation of these

data with the examination findings for those examined.

The Health Examination Survey is planned

as a continuous series of separate programs

called “cycles.” Each cycle is limited to specific

aspects of health within specified segments of the

U.S. population. The first cycle, 1960-62, was

designed primarily to provide data on the preva1
lence ofcertain chronic diseases andonthedistribution of various physical and physiological

measures in a defined adult population. 2JS

For the second cycle, 1963-65, the target

population was noninstitutionalized children 6.11

years of age. The examination and medical histories for this cycle were focused primarily on

health factors related to growth and development. 4+5

The findings on which this blood pressure

report is based are from the third cycle, which

was designed to obtain data on the health status

of the youth population with particular emphasis

on factors and conditions related to their growth

and development. For this program a probability

sample of the noninstitutionalized youths 12-17

years in the United States was selected and examined. The questionnaires, examination content,

and procedures were similar to those in the

children’s program in order to obtain comparable

information for the entire age range of childhood

through and beyond adolescence, but the earlier

survey methods were supplemented to obtain

data specifically related to adolescent health.

Included were a physical examination given by a

pediatrician assisted by a nurse, an examination

by a dentist, tests administered by a psychologist,

and a variety of tests and measurements by laboratory, X-ray, and health technicians. The survey

plan, sample design, examination content, and

operation of this survey program have been described in a previous report. G

Field collection operations for the youths’

cycle started in March 1966 and were completed

in March 1970. There were 6,768 youths examined,

90 percent of the 7,514 youths selected in the

national probability sample. This national sample

is representative, and the examined group is

closely representative, of the 22.7 million civilian noninstitutionalized youths 12-17 years in

the United States with respect to age, sex, race,

geographic region, population size of place of

residence, and rate of change in size of place of

residence from 1950 to 1960.

Examinations in the youths’ cycle, as in the

preceding program among children, were done

consecutively in 40 different locations throughout

the United States. During his single visit each

youth was given a standardized examination by

the medical team in the mobile units specially

designed for use in the survey. Prior to the examination, demographic and socioeconomic data

on household members as well as medical history, behavioral, and related data on the youth

to be examined were obtained from his parents.

In addition, a Health Habits and History form was

completed by the youth before he arrived for the

examination and a Health Behavior form was

completed by him while in the examination center.

Ancillary data were requested from the school

last attended by the youth including his grade

placement, the teacher’s rating of his behavior

and adjustment, and health problems known to

his teacher. A birth certificate was obtained for

each youth to verify his age and provide information related to his condition at birth.

The reliability and limitation of the blood

pressure measurements obtained in this survey

of youths are assessed in appendix I. Statistical

notes on the survey design, reliability of the

data, and sampling error are in appendix II.

Definitions of the demographic and socioeconomic

terms are in appendix III.

BLOOD PRESSUREMEASUREMENTS

Systolic and diastolic blood pressures were

measured as part of the cardiovascular examination that, in addition to a medical history,

included a routine auscultation of the heart by

the survey pediatrician, an electrocardiogram,

a chest X-ray, and an exercise tolerance test.

Three sets of blood pressure readings were

taken by the nurse—the first two at the beginning and end of the physical examination given

by the survey pediatrician with the youth in a

supine or prone position and the third immediately after the second with the youth sitting on

the edge of the examination table. The venipuncture was done between the first and second

reading.

Blood pressure was measured indirectly with

standard clinical mercury sphygmomanometers

of the type usually used in physicians’ offices and

in most surveys obtaining blood pressures. The

following guidelines, based on the American

Heart Association’s “Recommendations for Human Blood Pressure Determinations by Sphygmomanometers,” 7 were observed by the two

nurses who took these measurements:

2
. The cuff at least 20 percent wider than the

diameter of the examinee’s arm or covering approximately two-thirds of the arm.

(An adult 13 cm. cuff and a pediatric 9.5 cm.

cuff were available.)

● The nurse at eye level with the manometer.

●The meniscus checked weekly for zero-level

calibration.

● While measuring, the rate of fall in pressure

maintained at 2-3 mm. Hg per heartbeat,

which would be slow enough to detect the

first and last sounds but sufficiently rapid

to avoid intermittent trapping of blood between systolic and diastolic pressures.

● For diastolic pressure, the level recorded

was at the point of complete cessation of

Korotkoff’s sounds or, if no cessation, at

the point of muffling.

●Measurements were recorded to the nearest

2 mm. Hg on the measurement scale.

The middle of the cuff was placed over the

bulge in the upper right arm. Using the bell of

the stethoscope, the nurse noted and recorded

the pressure when the sound was first heard

(systolic) and the pressure when the sounds disappeared or, if no cessation, when the sound

first became muffled (diastolic).

This method of measurement provides results comparable with clinical findings. Howeverj

these indirect blood. pressure measurements may

differ from the true values that would be obtained

by direct (intra-arterial) measurement. The

direct and indirect methods of measurement

have been found to agree closely for systolic

pressure if the cuff size is appropriate to the

examinee’s height and arm girth. For diastolic

pressure, the agreement is not as good.use of

the American Heart Association criterion—the

point of complete cessation of sound or, if no

cessation, the point at which it first becomes

muffled-has been found to underestimate intraarterial diastolic blood pressure. However, using

the point at which the sounds first become muffled

produces a similar amount of bias in the opposite

direction. 8’9

Since blood pressure has been found to vary

considerably over a short period of time even

under relatively standard conditions ,10’11the basic

findings for systolic and diastolic blood pressure among youths in this report are shown

as the average of the three measurements taken,

assuming as has been done in the published findings &om the earlier Health Examination Surveys, that this is a better measure of the examinee’s actual pressure than the individual

readings would be. For comparison with the published findings among children from the 1963-65

Health Examination Survey, some data on the

average of the two prone measurements for

youths are also included.

FINDINGS

Age and Sex

Mean systolic blood pressure among youths

12-17 years of age in the United States consistently increases with age from 121.8 mm. Hg at

12 years to 132.9 mm. Hg at 17 years (table 1

and figure 1). As previously indicated, these

national estimates are based on the average of

the three blood pressure measurements obtained

in the Health Examination Survey of 1966-70

among a national probability sample of examinees

140 -

120 -

100 -

an –

60 –

o L

3.readingaverags fox

— Boys

. . . . ~r,$

DIASTOLIC

. . . ----- ......-

1 I I I I I

12 13 14 15 16 17

AGE IN YEARS

Figure 1. Mean systolic and diastolic blood pressure of youths

by age and sex: United States, 1966-1970.

3
representative of the

population at that time.

noninstitutionalized youth

Boys age 12-17 years tend to have higher

systolic pressure and the level increases more

rapidly with age for them than for girls age 12-17

years. For the total youth age range the mean

level for boys exceeds that for girls by 3.6 mm.

Hg, a difference that is statistically significant

(at the 5-percent probability level). The increase

with age from 12 to 17 years is 17.8 mm. Hg for

boys compared with only 4.3 mm. Hg for girls.

Only among the youngest youths, 12 years

of age, is the mean systolic pressure of girls

greater (significantly) than that of boys. From

14 years on, the mean systolic pressure of boys

substantially exceeds that for girls by values

that increase with age from 3.8 mm. Hg at 14

years to 9.2 mm. Hg at 17 years.

The variability in systolic pressure, as

measured by the standard deviation, increases

slightly with age from 11.3 mm. Hg at 12 years to

13.2 mm. Hg at 17 years. The variability is greater

among boys (standard deviation of 13.6 mm. Hg)

than girls (11.8 mm. Hg) and the increase in

variability with age is also larger (1.9 mm. Hg for

boys compared with 0.5 mm. Hg for girls over

the 6-year range). However, the relative variability in relation to the mean is generally similar

for boys and girls and shows no consistent agerelated trend.

At each of the selected percentile points in

the distributions of systolic blood pressure among

youths, there is a consistent increase in this preS -

sure with age from 12 to 17 years, the increase

being more than four times as large for boys as

for girls.

When tested for normality the distributions

of systolic pressure at each year of age are

significantly skewed to the right and/or leptokurtic (more peaked than in a normal distribution) among both boys and girls, the only exception being for 12- year-old girls, where the

distribution is essentially normal (table 2). The

distributions for both boys and girls become

slightly more skewed to the right and more

peaked with age.

The mean diastolic blood pressure (average

of the three readings) among youths 12-17 years

of age in the United States also increases with

age from 71.1 mm. Hg at 12 years to 77.9 mm.

Hg at 17 years (table 1 and figure 1). While the

mean diastolic pressures for boys and girls

12-17 years are nearly identical, the increase

with age is more rapid among boys than among

girls, an 8.9 mm. Hg increase from 12 to 17 Years

for boys compared with a 4.7 mm. Hg increase

for girls. For younger boys (12-14 years) mean

diastolic pressures are less than those for girls

while among older youths the pattern reverses.

Only at the extremes of the age range-12 and

17 years—are the mean differences large enough

to be considered statistically significant.

Although the variability in systolic pressures

increases with age, no such age-related trend

was found for diastolic pressures. There was

also no difference between boys (8.1 mm. Hg)

and girls (7.9 mm. Hg) in the variability of diastolic pressure among the youth population, as

measured by the standard deviation. At each percentile point in the distribution of diastolic pres -

sure, there was a nearly constant increase with

age from 12 to 17 years for both boys and girls.

Diastolic blood pressure tends to be more

nearly normally distributed among youths at

each year of age than systolic pressure (table

2). The distributions for diastolic pressure are

significantly skewed (to the right) and/or leptokurtic (more peaked than normal) except at 12

and 14 years for boys and at 12, 13, and 15 years

for girls.

Race

Among white youths in the United States,

mean systolic blood pressure consistently increases with age from 122.2 mm. Hg at 12 years

to 133.2 mm. Hg at 17 years (table 3 and figure

2). Similar to youths of all races combined, white

boys have higher mean systolic pressure and the

level increases more rapidly with age than for

white girls. At 12 years the mean level for white

girls exceeds that for white boys while from 14-17

years the reverse is found and the sex difference

increases with age. The tpean increase from 12

to 17 years for white boys is 18.0 mm. Hg and for

white girls 3.9 mm. Hg. Similarly the variability

in systolic pressure is greater among white boys

than among white girls and generally increases

slightly with age.

4
—

SYSTOLIC

3.readingaverw for:

---- Whh boys

— White girls

.. . . . . . . . Negro boys

---- Negro girls

OIASTOLIC

.

1 ! 1 1 I 1

12 13 14 15 16 17

AGE IN YEARS

Figure 2, Mean systolic and diastolic blood pressure of white

and Negro youths by age and sex: United States, 1966-1970.

Negro youths show patterns similar to those

for white youths of increasing systolic pressure

with age from 119.6 mm. Hg at 12 years to 131.6

mm. Hg at 17 years (table 4) and of higher mean

levels among boys than among girls (128.0 mm.

Hg compared with 125.4, respectively).

At each year of age the mean systolic blood

pressure of white youths is greater than that of

Negro youths, except among 13-year-old boys and

17-year-old girls. While this pattern of higher

systolic pressure among white than Negro youths

is fairly consistent, only at 15 years for boys and

girls and 17 years for boys are the mean differences large enough to be statistically significant

(or to probably reflect more than sampling variability).

The increase in systolic pressure with age

from 12 to 17 years is slightly greater among

white than Negro boys (18.0 mm. Hg compared

with 16.0 mm,. Hg), while the increase among

white girls is only half that among Negro girls

(3.9 mm. Hg compared with 7.9 mm. Hg).

The mean diastolic blood pressure of white

youths also consistently increases with age from

71.0 mm. Hg at 12 years to 77.7 mm. Hg at 17

years. While the mean levels for white boys and

girls are identical (74.6 mm. Hg), the increase

with age is twice as large among white boys

(8.7 mm. Hg) as among white girls (4.7 mm. Hg).

Among younger white youths mean levels for

girls exceed those for boys, while at age 15 years

and older the pattern is reversed. The variability in this measurement is similar among

white boys and girls and shows no age-related

trend.

Among Negro youths diastolic pressure also

increases with age from mean values of 71.8mm.

Hg at 12 years to 79.5 mm. Hg at 17 years. The

mean level among Negro boys slightly exceeds

that among Negro girls and the increase with age

for Negro boys (10.8 mm. Hg) is about twice that

for Negro girls (4.6 mm. Hg).

In contrast to the racial differences found

in systolic pressure, Negro youths have slightly

higher mean diastolic blood pressure than have

white youths across the age range in this study,

with the one exception for 16- year-old girls. The

mean diastolic pressure is 75.8 mm. Hg for

Negro youths and 74.6 mm. Hg for white youths

12-17 years, with the racial difference being

greater among boys (1.7 mm. Hg) than girls

(0.8 mm. Hg).

Findings are not included separately for other

racial groups since their proportion in the United

States and hence in the sample for this survey is

too small to provide reliable estimates for that

segment of the population. However, the national

estimates for all races combined do include those

groups.

Geographic Region

Although some regional differences in blood

pressure are noted here, these differences do not

follow a consistent pattern but appear to reflect

the differences between the nurse observers described in appendix I.

Mean systolic blood pressure is higher among

youths 12-17 years of age in the South and lower

among those in the West than among youths living

in either the Northeast or Midwest (table 5). Only

the mean difference in levels between those in

the South and West (1.7 mm. Hg) is large enough

to be statistically significant (at the 5-percent

level). Both boys and girls in the South had higher

mean systolic pressures and those in the West

5
had systolic pressures as low as or lower than

elsewhere, although the difference between the

extremes for either group is not large enough to

be statistically significant with the size and design

of the sample used in this survey. The States included in each of the four broad geographic regions

into which the United States was divided for the

probability sample selection used in this survey

are listed in appendix 111.

In each region the mean systolic blood pressure for boys exceeds that for girls and the increase from 12 to 17 years is more rapid among

boys than among girls.

Regional differences in the systolic blood

pressure levels of white youths are similar to

those for all youths—those in the South had the

highest mean values and those in the West had

the lowest (table 6). No such consistent pattern

of regional differences in systolic pressure is

evident among Negro youths, in part because of

the substantially smaller proportion of this race

in two of the regions. Negro youths in the South

have slightly higher mean systolic pressure and

those in the Midwest have lower levels than elsewhere (table 7); however, the mean differences

are too small to be of significance and are found

only among boys.

Youths in the Northeast have higher mean

diastolic blood pressure and those in the West

have lower levels than youths in the other two

regions. Only the mean difference between those

in the Northeast and West (1.3 mm. Hg) is statistically significant. This regional pattern in

diastolic pressure levels—significantly higher

mean levels among those in the Northeast than

West-is present among both boys and girls.

Mean diastolic pressure in each of the regions is similar for boys and girls but increases

substantially more rapidly with age for boys than

girls.

Among white youths, the mean diastolic pressure of those in the Northeast is significantly

higher than that of those in the West and South.

The mean diastolic pressure of white boys was

also significantly higher in the Northeast than

in the West and South, while only the NortheastWest mean difference among white girls is significant.

consistent than that for white youths. The mean

diastolic pressure of Negro youths in the Midwest is significantly higher (1.5 mm. Hg) than

that in the South. However, no significant regional differences in mean diastolic levels are

evident among either Negro boys or girls and

what regional pattern appears to exist differs

for the two groups.

Urban or Rural Area of Residence

No significant differences in either systolic

or diastolic pressures were found between youths

living in urban or rural areas. The mean,systolic

pressure of urban youths (table 8) was 128.2 mm.

Hg and the mean systolic pressure of rural youths

was 129.1 mm. Hg, a difference of less than 1 mm.

Hg. There was even less difference between the

mean diastolic pressures of urban (74.8 mm. Hg)

and rural youths (74.6 mm. Hg). A specific definition of urban and rural areas is found in appendix

III.

Family Income

No relationship is evident between income

level of the family and either the systolic or

diastolic blood pressures of youths. Mean pressure levels are similar (do not differ significantly) among youths in families with less than

$3,000, less than $5,000, $5,000-$9,999, and

$10,OOO or more annual family income for all

youths and for white and Negro youths (tables 9-11

and appendix III). Within each income level, the

mean systolic pressure is greater for boys than

for girls, and for lmth blood pressures the mean

increases more rapidly with age for boys than

for girls.

Education of Head of Household

Blood pressure levels of youths, either systolic or diastolic, show no relationship to the

education level of the head of their household

(their fathers, if present). As used here the education level is the highest grade of formal edu.

cation completed by the head of the household

(tables 12-14 and appendix III).

Comparison With Previous Health

Examination Survey Findings

The pattern of regional differences in dia- Background. —Blood pressure measurements

stolic pressure among Negro youths is less were obtained, as described, in the general cardio6
vascular part of the examination among adults

18-79 years in the Health Examination Survey of

1960-1962 12S13and among children 6-11 years in

the Health Examination Survey of 1963-1965, 14

as well as in the national survey among youths

12-17 years in 1966-1970, discussed in this

report,

Throughout each of these surveys the methods

were standardized and the quality of the data was

carefully monitored. However, before proceeding

with the comparison of findings from the three

national surveys, particularly since the levels

among youths are somewhat higher than expected,

consideration needs to be given to the differences

among the three surveys that might have influenced

the test results.

The effects of the major identifiable factors

present in the examinations of children and youths

but not of adults and in the examinations of youths

and adults but not of children which could have

affected the obtained levels are analyzed in appendix I. These factors include the timing of the

exercise tolerance test, given to both children

and youths but not to adults, in relation to blood

pressure measurement the extent of observer

variability in the examinations of children and

youths where blood pressure levels were determined by a small number of “nurses (4 in the examination of children and 2 in that of youths in

contrast to the 39 different physician observers

in the examination of adults); and the timing of

the measurement in relation to the venipuncture

procedure in the examination of youths and adults

but not of children. While the choice of cuff

(pediatric or adult size) for the youth examinees

could have influenced the obtained levels, the

size used was not recorded and hence the effect

of this factor cannot be assessed.

One factor common to all three surveys is

not considered here-the effect of the time of

day at which blood pressure was measured since

the scheduling of examinations of children and

youths was similar. In the Health Examination

Surveys of both adults and children, systolic

pressure tended to be slightly higher among

those examined in the afternoon than among

those examined in the morning. 12114

The exercise tolerance tests in the examinations of children and youths appear to have had

a negligible effect on the obtained blood pressure

levels in either survey. While youths whose blood

pressure was measured less than 20 minutes

after exercise did show some elevation in systolic level, the proportion with that order of examination schedule was so small (less than 1percent) that the overall effect on the national estimates for youths is negligible (less than 2 mm.

Hg). In appendix I the effect of the exercise

tolerance test on the blood pressure readings

in the two surveys is explored further.

Observer variability in blood pressure measurements has been shown to be substantial when

the measurements were obtained by a large

number of trained observers as in the 1960-1962

Health Examination Survey 12and when they were

obtained by either physicians 15 or nurses 16 in

previous smaller studies. However, the greater

the number of observers used in such a national

survey with standard procedures, the less likely

it is that the national estimates of blood pressure

will be substantially biased by the determinations

of any one or group of deviant observers. The

variability in systolic pressure levels obtained

by nurse observers in the children’s survey was

very small—a range of less than 3 mm. Hg among

median values obtained by the four observerscompared with the 4 mm. Hg difference in median

values between the two nurse observers in the

youths’ study. The nurse observers in the survey

of children showed more variability in diastolic

pressure measurements (range of 9 mm. Hg in

median values for observers) than did those in

the present study (median observer difference

of less than 2 mm. Hg).

As in the 1960-1962 survey of adults, the

mean systolic pressure levels obtained on the

first reading for youths in the present study were

3 mm. Hg or more above those for the second.

Since the timing of the venipuncture procedure

varied in the adult study, it was possible to assess

its effect on the blood pressure levels. In the

present study, however, it was done on each youth

between the first and second blood pressure measurement. Hence in this study it is not possible to

assess whether this procedure contributed significantly, if at all, to the elevation of the pressures

among youths.

While the examinees in the children’s survey

were in the prone position for both blood pressure

readings taken, those in the youths’ survey were

7
in the prone position only for the first two blood

pressure readings. Therefore the first two blood

pressures taken in the youths’ survey were averaged to provide a similar basis for comparison

with those blood pressures published for the

children’s survey. Tables 15-18 contain data comparable to that published for the children’s survey.

The total mean systolic blood pressure in table

15 is only 1.0 mm. Hg higher than that in table 1

(based on the average of all three readings), and

the total mean diastolic blood pressure in table

15 is only 1.4 mm. Hg lower than that in table 1.

In the earlier adult survey the examinees

were sitting for all three blood pressure measurements; therefore it is not possible to produce data for children and youths similar to

the data published for adults. For the sake of

convenience, however, tables 15-18 will also

be used in comparison with the adult survey.

Findings on systolic and diastolic blood pressures among youths are also presented in tables

19 and 20 for each of the three separate blood

pressure readings. In tables 19 and 20 the third

diastolic blood pressure reading is higher than

the two others. This is probably due to the fact

that the third blood pressure was taken with the

youth in the sitting position. Apparently the body

position of the examinee had an effect only on the

diastolic reading since the third systolic is lower

than the two others.

Hence the most likely of the identifiable

factors to have affected comparability of the

blood pressure levels obtained in the three national surveys appears to be the differences in

observers.

Age trend. —Systolic blood pressure levels

consistently increase with age from a mean of

105.9 mm. Hg at 6 years to 134.1 mm. Hg at 17

years, an annual increment of 2.6 mm. Hg or a

27-percent increase in systolic pressure during

that 12-year age range (figure 3, table 15, and

reference 14). The average annual increment is

greater among youths (2.3 mm. Hg per year) than

among children (1.6 mm. Hg per year). While the

increase between ages 11 and 12 years (9.0 mm.

Hg, which accounts for about one-third of the

12-year increase) is disproportionate in relation

to the trend for children (where the annual increment is consistently 2 mm. Hg or less per year),

it is more consistent with the trend among youths

“YL$2.redingaveraz.5for:

— Males

. . . . . . FmwIl~

.

g

a

L 80

g

I ~

OIASTOLIC A\ . . . .

.. . .. . . ..

2 . . . . .. . .

..<

. .. .

o I I I I 1 I 1 t I ! 1 I I

6 8 10 12 14 16 18.24

AGE IN YEARS

Figure 3. Mean systolic and diastolic blood pressure of males

and females 6-24 years of age: United States, 1960-1970.

(where the mean differences show a fairly consistent decreasing pattern with age from 9.0 between 11 and 12 years, 4.2 between 12 and 13

years, and down to 0.7 between 16 and 17 years).

Among boys, the increase in systolic pressure with age is substantially slower among

those 6-11 years old (average annual increment

of 1.3 mm. Hg per year) than among those 12-17

years old, where the average annual increment is

3.6 mm. Hg. In contrast the rate of increase in

systolic pressure among girls is twice as rapid

at ages 6-11 years (average of 1.9 mm. Hg per

year) as it is in the youths’ age range (average

of 0.9 mm. Hg per year).

The mean increment in systolic pressure

among boys from 11 to 12 years (8.1 mm. Hg)

accounts for one-fourth of the total mean increase

from 6 to 17 $ears and is substantially greater

than the trend a~ong those 6-11 years. At 11-12

years, however, the mean increment appears to

start a fairly consistent decreasing trend with

age among males 12-17 years decreasing from

8.1 mm. Hg between ages 11 and 12 to 6.5 between

12 and 13 and to 1.2 between 16 and 17 years,

8
Among girls, the annual increase in mean

systolic pressure remains at 2.2 mm. Hg or less

throughout the age range 6-17 years, with the exception of the disproportionate increase between

11 and 12 years of 9.9 mm. Hg which, whether

actual or an artifact of observer differences,

accounts for more than 40 percent of the total increase from ages 6 to 17 years and is not consistent with the trend in either half of the age

range.

The variability in systolic pressure levels

as well as the mean values increase with age

among both boys and girls, but the relative variability in relation to the mean values is less among

children than among youths (coefficient of variation values of 7-8 among children compared with

9-10 among youths), probably reflecting the somewhat greater differences among observers in the

youths’ survey than in the children’s survey.

Despite the substantial increase in mean

systolic pressures between ages 11 and 12 years,

the trend of higher mean values among girls

than among boys continues from 7 through 12

years and then reverses until by age 17 years

the mean levels for lmys exceed those for girls

by values as great as those among young U.S.

adults 18-24 years of age from the 1960-1962

Health Examination Survey. In addition, the mean

systolic pressure levels for boys 12-17 years

of age and for girls 10-17 years exceed those for

men and women 18-24 years old from the first

national survey, presumably, in part if not entirely, because of examiner differences among

the surveys (appendix I).

Similarly, for diastolic blood pressure there

is a generally consistent increase with age (but

less rapid than that for systolic pressure) from

the mean of 65.5 mm. Hg for 6-year-old children

to 76.8 mm. Hg for 17-year-old youths, an average annual increment of 1.0 mm. Hg. Among

children the average increase in diastolic pressure with age (0.3 mm. Hg per year) is substantially less than among youths (1.5 mm. Hg

per year). The diastolic pressure levels among

boys and girls do not show the inconsistency between ages 11 and 12 years which is apparent

in systolic pressures. However, the mean diastolic pressures for 17- year-old youths are about

6 mm. Hg above those from the 1960-1962 survey findings for young men and women. The

diastolic mean of boys 14-17 years old, and of

girls 12-17 years old exceed, respectively, those

of young men and young women 18-24 years of

age from the 1960-1962 survey.

Race.—The age-related trend in systolic and

diastolic blood pressure levels among the white

population 6-24 years of age in the United States,

as estimated from the first three Health Examination Surveys, is generally similar to that

described in the preceding section for persons of

all races (figure 4).

Negro boys show a substantially slower rate

of increase in systolic pressure at 6-11 years

than do white boys (0.5 mm. Hg per year compared with 1.4 mm. Hg) but only slightly less

increase at 12-17 years (figures 4-6). The increase between 11 and 12 years is also slightly

less for Negro boys, so their overall annual

increment at 6-17 years of age is below that

for white boys (2.3 mm. Hg compared with 3.1

mm. Hg). Among Nbgro girls the increase in

systolic pressure with age is similar across

both age groups, in contrast to the slower rate

2.reading average foc

— Males

. . . . . . Females

DIASTOLIC

.

0 , I 1 I I I I I I I t I I

8 8 10 12 14 16 18.24

AGE IN YEARS

Figure 4. Mean systolic and diastolic blood pressure of white

males and females 6-24 years of age: United States, 1960-

1970.
140r

24eding avms4 foc

— Mdlea

. . . . . . . Fem.les

6o1-

.$

1o~

6 8 10 12 14 16 18-24

AGE IN YEARS

Figure 5. Mean systolic and diastolic blood pressure of Negro

males and females 6-24 years of age: United States, 1960-

1970.

uL--’(- 2.rMding ~ for

_ -. White

— News

““CL-4=-’ ----

eol-

.L

1o~

6 8 10 12

AGE IN YEARS

Figure 6. Mean systolic and diastolic blood pressure of white

and Negro males 6-24 years of age: United States, 1960-

1970.

for white girls in the range 12-17 years (figure

7). However, because the increase between 11

and 12 years for the Negro girls is less than

that for white girls, the average annual increase

over the range 6-17 years is similar for girls

of both races (2.1 mm. Hg for white girls and

2.3 mm. Hg per year for Negro girls).

The increase in diastolic pressure with age

is similar but slightly slower among Negro boys

and girls than among white boys and girls, with

the exception of the slight reversal among Negro

boys 6-11 years where the trend with age is inconsistent.

Despite blood pressure levels among the

youths that were somewhat higher than expected,

the rank order of the race-sex specific mean

systolic pressures for the 1Lyear-olds in the

children’s survey is the same as for the 12-year -

olds in the youths’ survey-the highest mean

systolic pressures of white girls followed in

order by those of Negro girls and white boys,

and the lowest of Negro boys. With respect to

diastolic blood pressure, at ages 11 and 12

Negro girls had higher mean levels than white

girls had and the mean levels for Negro bovs

exceeded those for white boys.

140–

120 -

ml -

so -

e“ –

oL

“/

2.rMding awrws fon

---- w~ie

— NWO

DIASTOLIC

I I I I I I I I I I I I I

6 8 10 12 14 16 1s.24

AGE IN YEARS

Figura 7. Mean systolic and diastolic blood pressure of white

and Negro femalas 6-24 years of age: United States, 1960-

1970.

10
While the mean systolic blood pressure

levels among white and Negro young adults from

the first national survey are below those for the

17-year-olds in this present study, the mean

levels for males exceed those for females from

14-24 years in the white population and from

13-24 years in the Negro population. The rank

order in mean levels among these older age

groups also tends to be consistent, with the

highest levels among white males followed in

order by Negro males and femalesand white

females rankinglowest.The racialpatternis

lessconsistentforthediastolicpressurelevels.

Socioeconomic. -As in the national survey

of children, no association is evident between

the systolic or diastolic blood pressure levels

of youths and either the income level of their

families or the educational level of the parents

(tables A and B).

Longitudinal data. —In the 1966-70 Health

ExaminationSurveyof youths12-17years,the

same samplingareas and housingunitswere

utlilizedas in theprevious1963-65HealthExaminationSurveyof children6-11 years.As a

result, nearly one-third of the youths in the

present study had also been examined in the

Table A. Svstolic and diastolic median

blood pre~sures taken inthe prone position of youths 12-17 years by race and

family income: United States, 1966-1970

Blood I

Annual family income

pressure I I

and

race Less than $;;;X);- $10,000

$3,000 or more

Systolic Median pressure in

mm. Hg

All races- 128.2 I 128.1 I 127.8

I

White--------- 128.2 128.5 127.9

Negro--------- 128.1 125.4 127.4

Diastolic I I I

All races- 73.4 72.5 73.0

White--------- 72.6 72.3 72.9

Negro--------- 74.5 73.8 76.6

I I I

NOTE: All blood pressuresare the average of,the first two readings.

Table B. Systolic and diastolic median blood pressures taken in the prone position of

youths 12-17 years by race and education of parent: United States, 1966-1970

Education of parent

Blood pressure and race

Less than 5-8 9-12 13 years

5 years years years or more

Systolic Median pressure in mm. Hg

All races--------------------------------- 128.3 128.5 128.1 127.1

White ~egro------------------------------------------- 128.9 128.6 128.4 127.1

------------------------------------------- 126.7 128.3 125.5 127.2

Diastolic

All races--------------------------------- 73.3 73.5 72.8 72.4

White------------------------------------------- 72.6 73.2 72.7 72.3

Negro------------------------------------------ 74.9 74.6 73.7 73.9

NOTE: All blood pressures are the average of the first two blood pressure readings.

11
Children’s survey. This group

percent boys and 48 percent

included about 52

girls, as did the

total sample of examined youths. At the younger

ages of 12-14 years these data were available

for about 50 percent of all examined youths in

those ages but only about 25 percent at 15 years

and 1 percent at 16 years were available. The

time lapse between thetwo examinations ranged

from 28 months to 5 years, with a median time

lapse of 4 years.

The examinees were in the prone position

for both of the blood pressures taken in the

children’s survey and were in the prone position

for the first two blood pressures taken in the

youths’ survey. In addition, the procedure used

to measure blood pressures was the same” in

both surveys. Therefore a basis for comparison

of the blood pressures from the two surveys

exists, but comparison of the blood pressures

from the two surveys reflects survey differences

as well as actual change in the blood pressures

of the examinees. Since the reexamined group

is limited to those who remained in the same

location during both Surveys, were willing to

be reexamined, and were primarily in the age

range 12-15 years, the reexamined group cannot be considered typical of the total group of

youths.

To assess the typicalness of the reexamined

group with respect to blood pressures, tables 1

and 2 of the report on the blood pressures of

children 14 can be compared with table 21 of this

report and table 15 of this report can be compared

with table 22 of this report. When these comparisons are made, it may be seen that the mean

8ystolic pressure of the reexamined group when

they were children was 2.2 mm. Hg higher and

the mean diastolic pressure 0.7 mm. Hg higher

than the total mean for all children from the

previous survey. At the time of the survey of

youths, the mean systolic and diastolic pressure8

of the reexamined group were similar to those

for all youths 12-15 years.

Table 23 shows the increases in mean systolic

and mean diastolic pressures of the reexamined

group from the time their blood pressures were

taken in the survey of children to the time their

blood pressures were taken in the survey of

youths. The systolic pressures increased by an

average of 15.2 mm. Hg with the average increase

being 2.1 mm. Hg higher for boys than for girls.

The diastolic pressures increased by an average

of 4.6 mm. Hg, but in contrast with that for systolic pressure, the increase in diastolic pressures was 0.9 mm. Hg lower for boys than for

girls.

The amount of increase in both the systolic

and diastolic pressures was dependent upon the

number of months that had elapsed between the

time that the blood pressure of each examinee

was taken in the children’s survey and the time

that the blood pressure of each examinee was

taken in the survey of youths. As may be sien

in table 23, thi8 trend is more marked for the

systolic pressures than it is for diastolic pressures.

Comparison With Other Studies

Blood pressure level findings from six largescale studies among more geographically limited

groups of children and youths in the United States

are available for comparison with findings from

the present national study.

These include the longitudinal Child Research Council study of 1927-1967 among patients

of Denver physicians from which McCammon 17

reports blood pressure level findings for 249

boys and girls 6-17 years of age. More than

4,500 blood pressure measurements were obtained in this study by an unspecified number

of different observers.

Johnson et al 18 has reported findings from

the first round of examinations in 1959-1960 for

the total community study of Tecumseh, Michigan, residents including 2,509 in the age range

6-19 years.

Moss and Adams 9 published blood pressure

level findings in 1962 for 944 lmys and girls

6-17 years of age, but they do not indicate the

area or basis for selection of the children included.

Blood pressure level findings from one examination for 1,159 healthy children 6-15 years

of age seen in one physician’s office and outpatient clinic in St. Louis, Missouri, were reported by Londe19 in 1966.

Faber and James Z“ have reported blood

pressure findings obtained before 1920 for about

700 California schoolchildren and Graham et

al 21 have reported on the 1926-1940 longitudinal

12
Table C. Design characteristicsof selected studies of blood pressure among children and youths

Author

Mccmmonl’ . ----------------------- -

.Tohnaanet aL18--.----------------

Londt?’q..........-----------------

Moss-Adamay-----------------------

Faber-James

a

----------------------

Graham et al? --------------------

Ntwlth Lxmnination Survey---------

Health Examination Survey---------

Type and time

of Study

Longitudinal

1927-1967

Sin le time

195g-1960

Nat stated

W%g:rwl)

(Publishedin

1962)

Before 1920

1926-1940

Cross-sectional

1963-1965

Cross-sectional

1966-1970

&aminees

Source I Number (6-17 years)

Children,

Denver, Colorado

area

ChLldren,

Tecumseh, Michigan

Healthy children

seen in physician’s

office and clinic,

St. Louis, Missouri

Schoolchildren,

California

schoolchildren,

Minnesota

U.S. natioml

probability sample

ages 6-11 years

U.S. national

probability sample

ages 12-17 yeara

study of about 3,500 Minnesota schoolchildren

on whom more th”an 9,900 blood pressure measurements were obtained.

A description of the methods of blood pressure measurement used and other design characteristics for each of these studies is shown

in table C. However, there are so many factors

that may affect blood pressure measurementfactors that either cannot be controlled or that

differ, or factors that are not described in the

various studies, for example, examiners, equipment, conditions of the examination, or condition of the examinee-that at least small differences in mean levels among the various study

groups would be expected.

Mean systolic blood pressure levels of U.S.

boys and girls 6-12 years of age, as estimated

from the Health Examination Survey findings,

are within the range of mean values reported

from other studies. The values from the national study tend to be higher for youths 13-17

years, with the differences greater among boys

(mean differences of 6-8 mm. Hg at 14-17) than

among girls (mean differences of 2-6 mm. Hg

at 13.17 years) (figures 8 and 9). The systolic

pressure levels reported from McCammon’s

longitudinal study of Denver children 17are substantially lower than those from the other studies

249

(4,544measurements1

2,509 (6-19 years)

1,159

944

570

3,500

(9,901 measurements)

7,119

6,768

Methoda of measurements

Number of different examiners

not stated, child sitting,

diastolic muffled

49 examiners, child sitting,

diastolic disappearance

One examiner, child sqpine,

diastolic disappearance

DfaStOlk disappearance

WO examiners, child sitting,

diastolic muffled

One examiner, child sitting,

diastolic disappearance

Four examiners, child supine,

diastolic disappearance

wo =-miners, youth swine

(first two measurement only),

diastolic disappearance

_ United States (1%3.70)

--- Tecumeh (I W.ljO)18

“x: /- #/----

------

I 1 I I I I I 1 I 1 I 1 I I

6 a 10 12 14 la 18

AGE IN YEARS

Figure 8. Mean systolic, and diastolic blood pressure of bdys

by age from studies of Johnson et al (Tecumseh)$ a Londe

(St. Louis); 9 McCammon (Denver)j 7 Moss? and national

estimates for U.S. boys from the 1963-1970 Health Examina- : “

tion Survey.

13
_ United States(1963-70)

. . . . . ~ec”m~~~(]959 .6,3) 18

. . . . . . . . ~~,~ou,~(~g~q 19

---- Denver (1927.67] 17

---*Z

T--

;./ ..::-:-~eea..:+-=:”--

//

.--

o~

6 8 10 12 14 16 18

AGE IN YEARS

Figure9. Mean systolic and diastolic blood pressure of girls

by age from studies of Johnson et al (Tecumseh),18 Londe

(St. Loui8).lg McCammon (Denvar)J7 Moss,g and national

estimates for U.S. girls from the 1963-1970 Health Examination Survey.

at 6-14 for boys and 6-13 for girls and are among

the lowest for the remainder of the youth age

range. The systolic levels reported by Moss

and Adams 9 for youths are also among the lowest of those from the available studies. Greater

variabili~ is evident among the various study

findings for youths 12-17 years than for children

6-11 years of age.

Mean diastolic pressure levels for boys and

girls in the various studies, except for those

reported by Moss and Adams, 9 are in fairly

close agreement, differing by no more than might

be expected from observer variability alone

(4-8 mm. Hg) across the age range 6-k7 years

(figures 8 and 9). National estimates based on

Health Examination Survey findings tend to be

within the range of values from the other studies

(excluding those of Moss and Adams) for boys

6-12 years and girls 6-15 years and just slightly

higher (less than 3 mm. Hg) for the older youths.

If the diastolic pressure data of McCammon for

Denver children and Faber and James for California children had been determined at the point

of cessation of sound, those levels would have

been somewhat lower than shown.

The increase in systolic blood pressure

levels with age is more consistent for boys than

for girls among the various studies. The slightly

more rapid increase in ages 12-17 years than in

6-11 years found among boys in the national survey is generally consistent with findings from

the other studies. Similarly the slower increase

in diastolic than systolic pressure with age is

generally evident in the various studies discussed

here.

SUMMARY

This report presents national estimates of

blood pressures of youths ages 12-17 years,

based on findings of the Health Examination SurVey of 1966-70.

The estimates are derived from blood pressure measurements obtained from a probability

sample of 7,514 youths, representative of the

22.7 million youths in the noninstitutionalized

civilian population 12-17 years living in the coterminous United States. Of these youths, 90

percent were examined.

Three measurements were obtained on each

youth with the use of a sphygmomanometer. A

standard set of procedures was followed by the

two nurses responsible for the measurements.

Mean systolic pressures increased substantially with age from 121.8 mm. Hg at age 12 to

132.9 mm. Hg at age 17. Similarly mean diastolic pressures increased substantially but at

a somewhat slower rate from 71.1 mm. Hg at

age 12 to 77.9 mm. Hg at age 17.

The systolic pressures of girls were higher

than those of boys only at age 12, they were about

the same at age 13, and those of boys were higher at ages 14-17.

The diastolic pressures of girls were higher than those of boys at ages 12-14, but they

were higher for boys than for girls at ages 15-17.

The systolic pressures of white youths were

generally higher than those of Negro youths.

However, the diastolic pressures of Negro youths

were generally higher than those of white youths.

14
No relationship was found between the urban

or rural area of residence, parent education, or

family income of the youth and the youth’s systolic or diastolic blood pressures.

Comparisons with previous national estimates obtained from the Health Examination

Surveys of 1960-62 (adults’ survey) and 1963-65

(children’s survey) are included. Similarities

and differences between the three surveys are

noted. In general, the blood pressure levels,

particularly systolic, from the youths’ survey

are substantially higher than would have been

expected for youths of ages 12-17. Although

these findings are somewhat higher than expected, the sex- and race-related differences

are remarkably similar to those found in the

previous two surveys.

Comparison with findings from other largescale studies in various parts of the country indicate that the national estimates for youths age

12-17 years from the present survey, particularly for diastolic pressure levels, do not differ

from previous findings more than might be expected on the basis of observer variability. The

findings for systolic pressure of youths show

greater variability among the various studies

than do those for children.

Wuo

15
REFERENCES

1

National Center for Health Statistics: Origin,

program, and operation of the U.S. National Survey.

Vital and Health Statistics. PHS Pub. No. 1000-Series

1 -No. 1. Public Health Service. Washington. U.S.

Government Printing Office, Aug. 1963.

2National Center for Health Statistics: Plan and

initial program of the Health Examination Survey. Vital

and Health Statistics. PHS Pub. No. 1000-Series l-No. 4.

Public Health Service. Washington. U.S. Government

Printing Office,July 1965.

3National Center for Health Statistics: Cycle I of the

Health Examination Survey, sample and response,

United States, 1960-62. Vital and Health Statistics. PHS

Pub. No. 1000-Series 1l-No. 1. Public Health Service.

Washington. U.S. Government Printing Office, Apr.

1964.

4 National Center for Health Statistics: Plan,

operation and response results of a program of children’s

examinations. Vital and Health Statistics, PHS Pub. No.

1000-Series l-No. 5. Public Health Service. Washington.

U.S. Government Printing Office, Oct. 1967.

5 Nation~ Center for Health Statistics: Sample

design and estimation procedures for a National Health

Examination of Children. Vital and Health Statistics.

PHS Pub. No. 1000-Series 2-No. 43. Public Health

Service. Washington. U.S. Government Printing Office,

Aug. 1971.

6National Center for Health Statistics: Plan and

operation of a Health Examination Survey of U.S.

youths 12-17 years of age. Vital and Health Statistics.

PHS Pub. No. 1000-Series l-No. 8. Public Health

Service. Washington. U.S. Government Printing Office,

Sept. 1969.

‘committee to Revise Standardization of High

Blood Pressure Readings: Recommendations for Human

Blood Pressure Determinations by Sphygmomanometers.

New York. American Heart Association, Oct. 1951.

8Ragan, C., and Bordley, J.: The accuracy of clinical

measurements of arterial blood pressure, with a note on

the auscultatory gap. Bull. Johns Hopkins Hosp.

69(6):504, 1941.

‘Moss, A. J., and Adams, F. H.: Heart DLsease in

Infants, Children and Adolescents. Baltimore. The

Williams and Wilkins Co., 1968.

10Glock, C. Y,, Vought, R.

Schweitzer, M. D.: Studies

16

L,, Clark, E. G., and

in hypertension II.

Variability of daily blood pressure measurements in the

same individuals over a three-week period. J. Chronic

Dis. 4(5):469-476, NOV. 1956.

11Edwards, J. C.: Management of Hypertensive

Diseases. St. Louis. C. V. Mosby Co., 1960.

12National Center for Health Statistics: Blood

pressure of adults by age and sex, United States,

1960-1962. Vital and Health Statistics. PHS Pub. No.

1000-Series 1l-No. 4. Public Health Service. Washington.

U.S. Government Printing Office, June 1964.

1 3Nation~ Center for Health Statistics: Blood

pressure levels of adults by race and area, United States,

1960-1962. Vital and Health Statistics. PHS Pub. No.

1000-Series 11-No. 5. Public Health Service. Washington.

U.S. Government Printing Office, July 1964.

14National Center for Health Statistics: Blood

pressure levels of children 6-11 years: Relationship to

age, sex, race, and socioeconomic status, United States,

Vital and Health Statistics. Series 1l-No. 135. DHEW

Pub. No. (HRA) 74-1617. Washington. U.S. Government

Printing Office, Dec. 1973.

15 Rose, G. A., Holland, W. W., and Crowley, E. A.:

A sphygmomanometer for epidemiologists. Lancet,

1:296-300, Feb. 8, 1964.

16Wilcox, J.: Observer factors in the measurement

of blood pressme. Nurs. Res. 10(1):4-17, 1961.

1 7McCammon, R. W.: Human Growth and

Development. Springfield, 111. Charles C. Thomas Co.,

1970.

18Jobnson, B. C., Epstein, F. H., and Kjelsberg, M.

O.: Distributions and familial studies of blood pressure

and serum cholesterol levels in a total community—

Tecumseh, Michigan.]. Chronic Dis. 18:147-160, 1965.

19 Londe, S.: B10od pressure in children as

determined under office conditions. Clin. Pediatr.

5(2):71-78, Feb. 1966.

20 Faber, H. K., and James, C. A.: The range and

distribution of blood pressuxes in normal children. Am.

J. Dis. Child. 22:7-28,1921.

21 Graham, A. W., Hines, E. A., and Gage, R. P.:

Blood pressure in children between the ages of five and

sixteen years. Am. J. Dis. Child. 69:203-207, 1945.

22Nie, N.: Statistical Package for the Social

Sciences. New York. McGraw-Hill, Inc., 1970.
LIST OF DETAILED TABLES

Systolic and diastolic blood pressures of youths 12-17 years by age and sex,

shown by mean, standard deviation, standard error of the mean,selected percentiles, and population estimates: United States, 1966-1970----------------------- 19

20

2.

3.

S stolic and diastolic blood pressures of youtha

K

12-17 years by age and sex,

s own by percent distribution, skewness, and kurtosis: United States,1966-1970-

Systolic and diastolic blood pressures of white youths 12-17 years by age and

shown by mean, standard deviation, standard error of the mean,

~&ebtiies

selected

, and population estimates: United States, 1966-1970---------------- 21

22

23

Systolic and diastolic blood pressures of Negro youths 12-17 years by age and

sex, shown by mean, standard deviation, standard error of the mean, selected

percentiles, and population estimates: United States, 1966-1970----------------

4.

Systolic and diastolic blood pressures of youths 12-17 years by age, sex, and

region, shown by mean and standard error of the mean: United States, 1966-1970--

5.

6. Systolic and diastolic blood pressures of white youths 12-17 years by age, sex,

and region, shown by mean and standard error of the mean: United States, 1966-

1970--.”-------------- --------------------------- ------------------------------ 24

7. Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex,

and region, shown by mean and standard error of the mean:

1970

United States, 1966-

------------------------------------------- ---------------- ---------------- 25

26

Systolic and diastolic blood pressures of youths 12-17 years by age, sex, and

urban/rural status: United States, 1966-1970-----------------------------------

8.

9. Systolic and diastolic blood pressures of youths 12-17 years by age, sex, and

annual family income, shown by mean, standard deviation, standard error of the

mean, and median: United States, 1966-1970------------------------------------- 27

systolic and diastolic blood pressures of white youths 12-17 years by age, sex,

and annual family income, shown by mean, standard deviation, standard error of

the mean, and median: United States, 1966-1970---------------------------------

10.

29

Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex,

and annual family income, ahown by mean, standard deviation, standard error of

the mean, and median: United States, 1966-1970---------------------------------

11.

31

Systolic and diastolic blood pressures of youths 12-17 years by age, sex, and

education of parent, shown by mean, standard deviation, standard error of the

mean, and median: United States, 1966-1970-------------------------------------

12.

33

Systolic and diastolic blood pressures of white youths 12-17 years by age, sex,

and education of parent, shown by mean, standard deviation,

the mean, and median:

standard error of

United States, 1966-1970--------------------------------

13.

35

Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex,

and education of parent, shown by mean, standard deviation, standard error of

the mean, and median: United States, 1966-1970---------------------------------

Systolic and di~stolic blood pressures taken in the prone position of youths

12-17 years by age and sex, shown by mean, standard deviation, standard error

of the mean, and selected percentiles: United States, 1966-1970---------------

14.

37

15.

39

Systolic and diastolic blood pressurea taken in the prone position for white

youths 12-17 years by age and sex , shown by mean, standard deviation, standard

error of the mean, and selected percentiles: United States, 1966-1970---------

16.

40

17
17. Systolic and diastolic blood pressures taken in the prone position for Negro

youths 12-17 years by age and sex, shown by mean, standard deviation, standard

error of the mean, and selected percentiles: United States, 1966-1970--------- 41

18. Systolic and diastolic blood pressures taken in the prone position of youths

12-17 years by age and sex, shownbypercent distribution: United States, 1966-

1970--------------------------- --------------------------- -------------------- 42

19. Systolic and diastolic blood pressures of youths 12-17 years of all races by

age and sex for each of three separate readings, shown by mean and standard

error of the mean: United States, 1966-1970----------------------------------- 43

20. Systolic and diastolic blood pressures of white and Negro youths 12-17 years

by age and sex for each of three separate readings, shown by mean and standard

error of the mean: United States, 1966-1970----------------------------------- 44

21. Systolic and diastolic blood pressures taken during Cycle II on those examined

in both ‘Cycle II and Cycle III of the Health Examination Survey, shown by mean

and standard error of the mean--------------------------- --------------------- 45

22. Systolic and diastolic blood pressures taken during Cycle IIIonthose examined

in both Cycle 11 and Cycle III of the Health Examination Survey, ahown by mean

and standard error of the mean--------------------------- --------------------- 46

23. Increase in mean systolic and mean diastolic blood pressures of those examined

in both Cycle II and Cycle III of the Health Examination Survey, shown by difference between means--------------------------------------------------------- 47

18
Table 1. Systolic and diastolic blood pressures of youths 12-17 years by age and sex, shown’by mean,

standard deviation, standard error of the mean, selected percentiles. and population estimates:

United States, 1966~1970

Blood p:~dsur:, age, T’ Mean SX

Percentiles

s:

5th 10th 25th 50th 7.5th 90th 95th

n

Systolic

Both sexes 12-17

years--------------

Blood pressure in mm. Hg

0.32

0.43

0.38

0.43

0.38

0.53

0.50

0.31

0.59

0.53

0.49

0.60

0.51

0.53

0.40

0.48

0.51

0.60

0.43

0.74

0.73

1.22

).39

).39

).31

).21

).34

).29

).26

108.6

103.8

108.1

109.6

111.6

113.1

112.7

108.6

112.6

107.2

111.0

114.0

115.7

116.6

116.4

112.8

126.9

120.7

124.9

126.8

128.9

130.7

131.3

128.8

118.8

124.9

128.6

132.4

134.6

135.0

125.6

123.9

124.9

125.3

125.7

126.5

126.8

74.2

70.5

72.4

74.1

74.9

76.4

77.3

74.2

69.9

72.2

73.9

75.2

76.6

78.7

74.1

71.4

72.6

74.2

74.6

76.2

76.0

136.0

128.8

132.8

135.6

137.3

140.2

140.6

138.5

125.7

133.9

138.1

140.6

143.8

144.6

133.2

130.7

132.5

132.9

134.1

134.5

135.1

79.4

75.0

77.3

78.8

80.4

81.5

82.4

79.7

74.3

76.7

78.5

80.7

82.2

83.2

79.2

144.7

136.3

140.1

144.4

145.7

149.2

149.3

147.4

133.5

140.8

146.9

147.2

152.8

153.8

140.8

138.5

139.5

141.4

140.8

142.3

142:9

84.3

80.3

82.4

83.3

84.7

86.2

86.5

84.4

78.8

81.3

82.9

84.6

86.1

87.7

84.1

80.9

82.9

83.6

84.7

86.4

84.9

150.4

140.4

146.2

149.7

150.4

154.6

155.5

152.9

22,692

;,;3;

3;852

3,751

3,625

3,510

11,489

119.0

113.6

116.8

120.1

121.1

122.9

123.6

120.4

112.0

116.6

122.0

124.0

126.6

128.4

118.2

115.9

117.3

118.0

118.6

119.2

119.5

68.9

66.2

67.6

68.9

70.0

71,8

72.5

68.8

65.8

66.8

68.7

70.5

71.9

74.1

69.0

E

14

15

16

17

12

::

15

16

17

12

13

i:

16

17

12

13

;;

16

17

12

13

14

15

16

17

12

13

14

15

H

121.:

126.C

128.C

130.2

132.4

11.:

11.[

12.:

12.:

13.(

13.:

13.(

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

BOYS 12-17

years--------------

132.$

130.:

138.0

148.1

151.6

151.6

158.2

160.2

146.8

143.3

144.5

146.7

148.8

148.3

148.5

87.1

82.6

85.6

:$:

89:1

89.8

87.2

2,032

2,006

1,951

1,900

1,836

1,764

11,203

119.7

126.2

130.5

133.:

136.:

137.5

10.8

12.4

12.2

11.9

13.0

12.7

11.8

11.5

11.3

12.0

12.0

11.6

12.0

8.o

;:$

7.6

7.7

7.7

7.7

8.1

102.5

107.0

110.8

115.2

116.9

119.1

108.6

106.2

110.7

114.7

117.9

120.7

122.6

112.3

109.0

111.6

112.8

113.6

114.4

113.3

64.3

60.9

62.5

64.6

66.1

67.4

68.1

64.2

60.8

62.2

64.4

66.4

68.1

69.8

64.4

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17

years-------------- 126.7

1,970

1,946

1,901

1,851

1,789

1,746

22,692

4,002

3,952

3,852

3,751

3,625

3,510

11,489

124.(

125.:

126.7

127.:

128.:

128.:

106.1

108.7

108.4

109.2

111.0

110.6

61.2

58.4

59.6

62.1

62.9

64.0

64.8

61.0

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Diastolic

Both sexes 12-17

years-------------- 74.7

71.1

73.0

74.4

75.7

77.0

years------------------

years ------------------

years------------------

years------------------

years------------------

years------------------

BOYS 12-17

years--------------

77.9

74.8

82.5

85.1

86.0

88.3

88.3

90.7

87.0

82.6

86.2

87.0

87.4

89.8

88,0

2,032

2,006

1,950

1,900

1,836

1,764

11,203

1,970

1,946

1,901

1,851

1,789

1,746

70.4

72.5

74.2

76.0

77.3

79.3

).50

).55

).42

).33

).43

).28

).23

).42

).36

).31

).26

).40

1.46

58.4

59.5

62.0

63.6

64.8

66.7

61.3

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17

years-------------- 74.7

66.9

68.3

69.0

69.4

71.7

71.6

76.5

78.1

79.1

80.0

80.7

80.6

71.9

73.5

74.7

7.6

7.8

7.7

i::

7.5

58.6

59.8

62.4

62.5

62.6

64.2

61.2

63.1

64.7

65.2

66.6

66.7

years ------------------

years------------------

years------------------

years------------------

years------------------

years------------------

75.3

76.7

76.6

NOTE: Sx= standard deviation; SE= standard error of the mean; n= estimated number of youths in

population in thousands; all blood pressures are the average of three readinga.

19
Table 2. Systolic and diastolic blood pressures of youths 12-17 years by age and sex, shown by percent

distribution, skewness, andkurtosis: United States, 1966-1970

Blood pressure

inmm. Hg

Systolic

Total-------

T&d% 90----------

- --------------

1oo-1o9-----------

11o-119-----------

120-129-----------

130-139-----------

140-149-----------

150-159-----------

160-169-----------

170-179-----------

180-189-----------

190-199-----------

200 and over------

Skewnessl---------

Kurtosisl---------

Diastolic

Total-------

Under 40----------

40-49-------------

50-59-------------

;:-;;-------------

-------------

i3::&-----------

-------------

lo;-lo9-----------

11o-119-----------

120 and over------

Skewness----------

Kurtosis----------

Boys Girls

12

years

100.0

1!:;

33.2

30.5

14.9

::;

0.1

.

0.4

0.4

100.0

0.7

6.8

39.2

44.1

::;

0.1

0.1

13 14 15 16 17 12 13 14 15 16 17

years years years years years years years years years years years

I I I I I I I I I I

Percent distribution

100.0

0.;

2::2

29.2

23.4

9.2

M

:::

0.4

0.6

100.0

:::

30.8

47.7

14.2

:::

0.2

0.4

1.5

100.0

3.6

13.9

34.8

26.7

13.7

6.0

1.0

0.3

0.4

0.1

100.0

2::;

:;.:

2:4

0.1

0.1

100.0

1!:?

26.8

30.9

2;.:

1:1

::;

0.1

0.6

1.2

100.0

:.;

18:6

46.2

29.0

3.8

0.;

0.2

1.4

,00.0

1.;

2:::

27.5

22.4

11.7

3.4

U

0.;

0.6

1.1

,00.0

1::;

48.2

33.9

3.6

0.1

0.1

0.2

1.4

LOO.O

-

:::

23.5

32.3

23.4

10.6

4.1

0.7

0.5

o.i

0.8

1.7

LOO.O

0.1

4::2

39.4

M

0.1

0.5

2.6

.00.0

0.3

1.6

2;::

33.7

22.0

7.3

1.4

0.0

0.0

.00.0

0.5

3::!

48.3

14.7

1.0

-

-

0.0

0.4

100.0

0.;

2:::

35.9

24.3

9.0

1.6

0.2

0.1

0.2

0.5

LOO.0

:::

25.7

48.6

2;.:

0;4

0.1

0.5

100.0

0.;

22::

36.9

22.0

9.5

~:;

.

0.5

0.7

1.9

100.0

2:::

49.8

21.4

;::

-

0.3

0.5

100.0

R

21.4

35.0

2;.;

3:3

1.0

0.4

0.2

0.6

1.4

100.0

2::;

48.1

2:.;

.

-U

100.0

o.i

2:::

34.8

26.1

10.4

3.2

0.8

$:

-

0.8

1.5

LOO.O

1:::

;2$;

5:8

0.6

:.:

.

100.0

0.;

2;::

34.4

25.6

11.3

3.4

0.7

%;

-

0.6

1.1

100.0

.

-

1!::

50.3

29.3

2.7

1.0

.

0.3

1.1

lFor skewness, P= =.18, PI =.26; for positive kurtosis, p== i-.37,P,= +.60 - the probability levels

based on simple ran~om sampling theory for sample sizes of 5~0 which wi-llsomewhat understate the probability levels from the complex sample design used in this survey.

NOTE: All blood pressures are the average of three readings.

20
Table 3. Systolic and diastolic blood pressures of white youths 12-17 years by age and sex, shown by

mean, standard deviation,

United States, 1966-1970

standard error of the mean, selected percentiles, and population estimates:

Blood p~n;su&, age,

Percentiles

8X

5th 10th 25th 50th 75th 90th 95th

Mean Sx n

systolic

Both sexes 12-17

years--------------

Blood pressure in mm. Hg

128.8

122.2

126.1

128.8

130.9

132.7

133.2

130.7

12.9

11.5

11.8

12.2

12.3

12.9

13.4

13.7

0.37

0.50

0.48

0.47

0.45

0.52

0.56

0.37

108.9 112.8 119.4 136.2 145.1 150.8 19,552

12

13

14

15

16

17

12

13

g

17

12

13

::

16

17

12

13

14

15

16

17

12

:;

;:

17

12

13

14

15

K

104.1

108.5

110.1

112.8

114.0

112.6

108.9

107.4

111.6

114.3

116.3

117.0

116.3

113.1

106.4

111.1

115.0

L18.8

L20.9

L23.2

L12.7

114.0

116.9

120.3

121.9

123.2

123.6

120.8

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Boys 12-17 years----

120.5

124.:

126.5

129.6

130.7

131.{

129.2

129.5

132.8

135.6

137.9

140.3

140.9

138.8

126.2

133.6

138.1

140.9

144.2

145.0

133.4

131.1

132.5

132.9

134.3

134.5

134.9

79.2

74.8

76.9

78.5

80.4

81.2

82.2

79.4

136.6

140.2

144.3

146.4

149.4

150.0

147.8

140.7

146.4

150.2

150.8

154.8

155.9

153.5

3,432

3,396

3,318

3,240

3,136

3,030

9,929

120.1

126.1

130.8

133.8

136.7

138.1

126.9

10.9

12.3

12.2

11.9

13.1

12.7

11.8

0.68

0.64

0.50

0.76

0.48

0.53

0.44

102.7

107.6

111.2

115.9

117.5

120.0

108.9

112.1

116.6

122.5

;;;.:

128:7

118.4

116.0

117.6

118.2

119.2

120.0

119.0

68.9

66.2

67.4

68.8

69.9

71.7

72.4

68.8

65.7

66.7

68.6

70.4

71.3

74.0

69.0

119.C

124.7

128.t

132.7

134.7

135.7

125.9

134.2

140.8

147.6

147.5

153.3

154.6

140.9

138.8

139.6

141.0

141.9

142.0

143.0

84.2

80.2

82.1

83.0

84.6

85.9

86.3

84.2

78.7

80.8

82.7

84.6

85.5

87.0

84.0

138.2

147.8

152.3

151.9

158.2

162.0

147.1

1,747

1,729

1,685

1,646

1,594

1,528

9,623

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17 years---

124.3

126.2

126.8

127.9

128.5

128.2

74.6

71.0

72.7

74.3

75.6

76.9

77.7

74.6

70.3

72.2

74.0

75.8

77.0

79.0

74.6

71.7

73.3

74.6

75.3

76.8

76.4

11.6

11.3

12.0

12.1

11.3

12.1

7.9

7.4

7.7

7.4

;:;

7.6

8.0

0.55

0.62

0.68

0.45

0.74

0.78

0.25

0.43

0.44

0.36

:.;;

0:28

0.29

106.2

109.0

108.8

110.3

L12.2

L1O.7

61.0

58.4

59.6

62.1

62.9

64.0

64.7

60.9

58.3

59.6

62.0

63.6

64.5

66.4

61.3

58.6

59.5

62.2

62.5

62.8

64.2

L09.2

L12.1

L13.5

L14.5

L14.7

L13.2

64.3

60.7

62.4

64.6

65.8

67.5

68.0

64.2

60.5

62.2

64.4

66.4

67.9

69.1

64.4

60.9

63.0

64.7

64.9

67.0

66.8

124.2

125.5

125.2

L26.3

126.8

126.5

74.1

70.4

72.3

73.9

74.8

76.3

77.1

74.1

144.2

144.8

146.6

149.5

148.1

148.7

86.8

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Diastolic

Both sexes 12-17

years--------------

1,685

1,667

1,633

1,594

1,542

1,502

19,552

3,432

3,396

3,318

3,240

3,136

3,030

9,929

1,747

1,729

1,685

1,646

1,594

1,528

9,623

82.5

84.8

86.1

88.0

89.0

89.4

86.9

82.5

84.4

85.8

88.3

88.2

90.4

86.8

years ------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Boys 12-17 years----

7.2

7.6

7.3

7.6

7.6

7.6

7.8

7.5

;::

7.6

7.8

7.4

0.53

0.59

0.46

0.38

0.49

0.35

0.25

0.49

0.41

0.39

D.30

D.37

D.44

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17 years---

69.9

72.1

73.3

75.1

76.4

78.4

74.1

74.2

;;.:

80:6

82.0

82.9

79.0

76.1

77.8

78.7

80.2

80.7

80.1

66.7

68.2

68.9

69.3

71.9

71.4

71.0

72.5

74.1

74.6

76.2

75.7

80.7

82.7

83.6

84.6

86.3

84.7

82.5

85.3

86.6

87,0

89.7

87.9

1,685

1,667.

1,633

1,594

1,542

1,502

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

NOTE: SX= standard deviation; SE= standard error of the mean; n= estimated number of youths in

population in thousands; a11 blood pressures are the average of three readings.

21
Table 4. Systolic and diastolic blood pressures of Negro youths 12-17 years by age and sex, shown by

mean, standard deviation, standard error of the mean,

United States, 1966-1970

selected percentiles, and population estimates:

‘n

3,024

552

538

522

476

474

462

1,496

280

263

256

241

231

225

1,528

272

275

266

235

243

237

3,024

552

538

522

476

474

462

1,496

280

263

256

241

231

225

1,528

272

275

266

235

243

237

Percentiles

[can s

x 8X

5th 10th 25th 50th 75th 90th 95th

Systolic

Both sexes 12-17

years--------------

Blood pressure in mm. Hg

L07.1

101.6

LOS.8

L.08.9

109.2

110.7

L13.1

L07.1

.26.7

.19.6

.25.4

.27,6

.26.6

;30.9

!31.6

128.0

L17.5

L26.7

L28.8

L29.1

L35.1

L33.5

L25.4

L2.5

LO.3

12.2

L2.2

L1.4

13.4

11.6

13.1

0.60

0.93

0.94

1.07

1.16

1.71

1.44

0.70

1.20

1.91

1.31

1.15

1.62

1.64

0.72

1.33

0.68

1.40

1.59

2.12

2.28

0.32

0.47

0.55

0.53

0.65

0.90

1.20

0.63

.10.7 .17.0 ,25.5 34.6

25.8

33.1

36.7

34.4

38.7

38.5

36.5

,22.8

,34.6

,38.2

,36.1

,42.6

,40.5

,33.0

.28.1

.31.6

.32.8

.32.8

.34.8

.36.4

80.9

42.8

32.1

40.2

45.2

41.6

47.6

45.4

45.4

28.8

42.9

46.5

44.4

51.4

47.2

40.8

34.6

38.8

43.7

36.6

46.1

42.9

85.7

,47,5

.38.4

.44.9

.48.0

.44.6

.52.0

.49.8

.49.5

.32.9

.48.6

.48.6

.48.8

.52.0

.52.3

.44.6

.38.9

.44.0

!47.5

!41.6

149.8

L47.4

89.0

!06.2

!08.7

!11.6

U1.4

114.2

U8.O

L1l.2

.12.2

.16.1

.18.3

.16.7

.19.2

.23.5

.18.2

.19.5

,24.5

.26.3

,25.2

,30.3

,29.8

.26.8

.17.0

.26.6

.27.1

.28.7

.34.2

.32.3

.24.4

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

BOYS 12-17 years----

l?::

12.1

11.7

12.5

11.7

11.8

LOO.6

LOS.2

L1O.3

L1O.4

L13.8

L13.7

L07.0

L04.8

L07.8

L12.8

L14.7

118.4

L19.1

L1O.5

.10.9

!16.3

L19.5

!18.3

L26.7

L24.5

LS6.5

12

13

14

15

16

17

years ------------------

years------------------

years------------------

years------------------

years-----------------

years------------------

Girle 12-17 years---

L13.7

L15.8

L16.9

L14.8

L16.3

L22.5

69.6

66.9

68.4

70.0

70.4

72.7

73.0

70.0

.21.7

.22.7

!25.7

!22.7

L24.4

L27.9

75.0

70.8

73.8

74.8

75.4

77.2

79.5

75.9

L21.8

L24.2

L26.4

L24.O

L26.9

L29.7

75.8

71.8

74.8

75.8

76.2

77.7

79.5

76.3

10.6

11.2

12.2

10.5

13.1

11.1

8.4

7.4

9.1

7.9

8.2

7.E

7.g

8.6

L02.6

106.5

107.3

106.9

110.0

112.1

62.1

58.8

59.8

62.8

62.1

64.2

66.2

62.3

L08.3

L1O.O

L1O.6

L1O.0

L1l.5

L17.3

64.7

62.2

63.1

64.7

67.4

66.9

70.7

64.6

years ------------------

years ------------------

years------------------

years------------------

years------------------

years------------------

Diastolic

Both sexes 12-17

years--------------

76.6

79.7

80.9

80.7

82.5

83.0

81.7

82.9

88.3

89.1

90.0

89.8

90.9

89.4

82.4

90.6

89.1

90.3

88.6

94.4

88.6

85.5

87.7

;3.:

91:7

90.3

81.0

85.3

84.9

86.2

87.2

88.0

85.8

years ------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Boys 12-17 years----

:7.:

85:2

84.9

87.3

90.1

85.6

81.9

84.8

84.0

86.5

86.9

87.2

70.8

74.7

75.9

76.9

79.4

81.6

75.4

0.72

1.48

1.10

0.65

1.13

1.26

0.65

58.9

59.1

62.5

62.4

67.6

71.8

61.5

62.2

62.7

64.7

67.2

70.2

72.4

64.8

66.3

67.1

70.0

70.8

74.2

76.3

69.4

69.7

73.9

75.7

76.3

78.8

81.3

74.5

74.9

;:.;

81:5

82.9

84.2

80.3

12

13

14

15

16

17

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17 years---

72.9

74.8

75.7

75.5

76.1

77.5

0.78

1.27

0.69

1.09

1.13

1.79

58.6

60.4

63.2

59.5

62.1

64.2

62.3

64.5

64.7

67.5

::.:

.

67.6

68.9

70.0

69.7

69.7

72.4

72.4

73.7

74.5

74.2

75.4

76.7

77.6

79.9

81.0

79.1

80.4

82.3

12 years------------------

13 years------------------

14 years------------------

15 years------------------

16 years------------------

17 years------------------

NOTE: 8X= standard deviation; S-= standard error of the mean; $t= estimated number of youths in

population in thousands; all blood p%eskures are the average of three readings.

22
Table 5. Systolic and diastolic blood pressures of youths 12-17 years by age, sex, and region,

shown by mean and standard error of the mean: United States, 1966-1970

Northeast Midwest south West

Blood pressure, age, and sex

Mean Sz Mean SF Mean %

Mean %

Systolic Blood pressure in mm. I@

Both sexes 12-17 years---------------- 0.39 128.4

122.4

125.7

127.9

130.0

132.8

132.8

129.7

119.2

124.8

129.1

132.4

136.8

137.7

127.1

125.6

125.6

126.7

127.1

128.6

128.5

7.5.0

71.9

72.8

75.0

76.0

77.2

77.7

74.6

71.0

71.9

74.2

76.1

77.0

78.2

75.3

0.87 129.4

122.3

127.2

129.4

130.9

133.0

134.0

131.6

121.0

128.8

130.7

133.5

136.5

138.8

127.2

123.7

125.5

128.1

128.4

128.6

128.9

74.5

71.0

73.4

73.8

75.3

76.3

77.4

74.9

0.35

0.55

0.44

1.12

0.65

1.08

1.20

0.39

0.65

0.82

1.56

0.67

1.03

1.44

0.43

0.71

0.77

0.81

0.82

1.22

0.93

0.22

0.27

0.47

0.45

0.39

0.59

0.42

0.32

128.6 127.7 0.53

120.9

126.7

128.8

129.8

133.7

133.8

130.5

119.1

126.7

131.1

132.4

137.9

139.6

126.7

122.8

126.7

126.2

127.2

129.6

128.3

75.4

71.4

73.7

74.8

76.3

78.8

79.0

75.7

70.8

72.8

75.1

76.9

80.0

80.9

75.2

0.65

0.89

0.75

1.11

0.77

0.60

0.63

0.89

1.16

0.62

2.02

0.89

0.35

0.47

0.95

1.09

1.22

0.72

1.50

0.82

0.29

0.48

0.34

0.69

0.70

0.61

0.50

0.44

0.74

0.72

0.66

1.17

0.79

0.60

0.27

1.23

0.99

0.96

0.79

0.65

1.41

0.83

1.88

1.40

1.09

1.17

0.80

1.51

0.96

0.81

0.93

1.61

0.91

1.34

1.92

0.79

1.26

1.41

0.83

0.41

0.72

0.75

0.91

1.73

1.82

0.90

0.54

1.08

0.96

0.69

121.5

124.8

128.5

130.5

130.5

131.4

129.7

:;;.;

131:1

134.7

134.8

134.5

125.7

123.5

124.7

125.7

126.5

126.7

127.6

74.1

70.0

72.2

74.1

75.0

76.0

77.7

74.1

1.23

0.71

0.46

0.74

1.17

0.46

0.47

1.12

0.96

0.91

1.16

1.56

1.20

0.69

1.47

1.06

0.73

0.96

1.40

1.57

0.30

0.80

0.46

0.65

0.50

0.50

0.52

0.27

~ears.................----------.........

years------------------------------------

years------------------------------------

years----..---..--.-.--------------=-----

Boys 12-17 years------------------------

years------------------------------------

years.-.---=-----------------------------

years.--.---------=----------------------

years------------------------------------

years------------------------------------

Girls 12-17 years-----------------------

years------------------------------------

~ears------------------------------------

years--------------------------- ---------

years------------------------------------

Diastolic

Both sexes 12-17 years----------------

years------------------------------------

years------------------------------------

years------------------------------------

years------------------------------------

years------------------------------------

Boys 12-17 years------------------------

0.60

0.98

0.95

0.54

0.71

0.38

0.39

1.53

0.36

0.58

0.61

0.79

0.98

years ------------------------------------

years--------------s-------------------years--.--- ....-..-=-=-------------------

years------------------------------------

years-.=---------------------------------

years------------------------------------

70.3

73.8

73.4

75.4

76.7

80.0

74.1

71.7

;:.;

75:2

75.9

74.8

0.59

0.75

0.90

0.37

0.44

0.43

0.36

0.47

0.78

0.49

0.61

1.00

0.61

69.3

71.8

74.0

75.5

75.8

78.4

74.1

—-

70.8

72.5

74.2

74.6

76.1

76.9

Girls 12-17 years-----------------------

71.9

74.7

74.6

75.7

77.7

77.3

0.75

0.38

0.89

0.75

0.63

0.66

72.8

73.7

75.7

75.8

77.4

77.2

0.96

1.07

0.86

0.51

0.68

0.75

years------------------------------------

years------------------------------------

years------------------------------------

years-.-----------------------=----------

years------------------------------------

NOTE: Sr= standard error of the mean; all blood pressures are the average of three readings.

23
Table 6. Systolic and diastolic blood pressures of white youths 12-17 years by age, sex, and region, shown by mean and standard error of the mean: United States, 1966-1970

Northeast \ Midwest I South I West

Blood pressure, age, and sex

Kean s. Mean 53 Mean 53

x

Systolic Blood pressure in mm. Hg

130.1

123.4

127.2

130.3

131.7

133.5

134.4

132.3

122.2

128.1

131.3

134.2

136.4

140.4

127.9

124.6

126.3

129.3

129.3

129.3

128.2

74.3

71.1

72.8

73.3

75.3

76.0

76.9

74.3

70.1

72.9

72.4

75.0

76.0

79.1

74.2

72.1

72.8

74.2

75.6

76.0

74.5

Both sexes 12-17 years ---------------- 129.0

121.0

127.2

128.7

130.8

134.0

134.3

131.0

0.48

0.66

1.16

0.68

1.43

0.87

0.95

0.79

128.7 1.02 0.47

0.45

0.47

1.49

0.84

0.90

1.34

0.46

127.8

121.4

124.8

128.4

131.0

130.6

131.6

129.9

0.53

1.32

0.74

0.26

0.86

1.23

0.55

0.47

12 years ---------..........-.-..---.........

13 years------------------.---=-------------

14 years......---------------------.,--------

15 years--.------=--------------------------

16 years------------------------------------

17 years--.=---=----------------------------

1.39

1.25

1.04

0.84

0.84

1.55

1.02

123.0

125.9

128.2

130.4

133.0

133.0

Boys 12-17 years------------------------ 130.0

12 years------------------------------------

13 years------------------------------------

14 years ------------------------------------

15 years ------------------------------------

16 years ------------------------------------

17 years------------------------------------

;;; .;

131:1

133.5

138.2

140.4

126.8

0.77

1.46

0.47

2.54

0.95

0.42

0.44

119.6

125.0

129.7

132.6

137.2

138.0

127.5

2.03

1.84

1.13

1.32

0.91

1.52

1.07

0.82

0.59

1.90

0.60

0.85

1.20

0.51

0.82

0.64

1.14

1.17

1.23

1.12

0.26

0.39

0.47

0.44

0.52

0.42

0.42

0.32

119.8

124.8

131.2

135.4

135.1

134.9

125.7

123.1

124.7

125.6

126.9

126.6

127.7

73.9

69.5

72.0

73.9

75.2

75.9

77.4

74.0

1.37

0.80

0.53

1.32

1.58

1.23

0.70

1.42

1.19

0.85

1.10

1.37

1.59

0.30

0.74

0.43

0.64

0.50

0.51

0.50

0.28

Girls 12-17 years-----------------------

12 years--------------------.----=----------

13 years--------------------------- .---.,-----

14 years-------------------------------------

15 years-s-”--------------------=-----------

16 years------------------------------------

17 years------------------------------------

122.7

127.0

125.9

128.0

130.2

127.9

75.4

0.89

1.38

1.43

0.78

1.46

1.04

0.24

126.3

126.8

126.7

127.8

128.8

128.7

74.8

0.92

1.09

1.79

1.04

1.45

1.99

0.85

Diastolic

Both sexes 12-17 years ----------------

12 years---------=--------------------------

13 years------------------------------------

14 years.---..............------------------

15 years------------------------------------

16 years------------------------------------

17 years--------------------.--.,-------------

71.3

73.6

74.7

76.1

78.8

79.2

75.8

0.48

0.17

0.78

0.78

0.78

0.44

0.43

71.8

72.6

75.0

75.8

77.1

77.5

74.4

1.32

1.52

0.97

0.37

0.81

0.80

Boys 12-17 years------------------------ 0.99

12 years ------------------------------------

13 years------------------------------------

14 years ------------------------------------

15 years ------------------------------------

16 years ------------------------------------

17 years------------------------------------

70.9

72.7

75.2

76.8

79.8

81.2

75.0

0.68

0.65

0.61

1.37

1.04

0.80

0.26

70.9

71.7

74.1

75.8

76.8

77.9

75.3

1.72

2.01

1.10

0.50

1.21

1.07

0.74

0.70

;.;;

0:43

0.50

0.49

0.44

69.2

71.8

73.9

75.7

75.8

78.1

73.8

0.68

0.81

0.94

0.71

0.75

0.53

0.37

1.41

0.40

0.62

0.56

0.79

0.96

Girls 12-17 years-----------------------

12 years------------------------------------

13 years=-----------------------------------

14 years------------------------------------

15 years------------------------------------

16 years-.-----------------w-----------------

17 years------------------------------------

71.7

74.6

74.2

75.3

77.8

77.0

0.82

:.;:

0:62

0.65

0.93

72.7

73.5

75.8

75.8

77.5

77.1

1.09

1.15

0.95

0.58

0.75

0.79

0.59

0.79

0.65

0.91

0.79

0.62

70.0

72.3

73.9

74.7

75.9

76.6

NOTE: S% = standard error of the mean. All blood pressures are the average of three readings.

24
Table 7. Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex, and region, shown by mean and standard error of the mean: United States. 1966-1970

Northeast Midwest South West

Blood pressure, age, and sex I I I I

Mean SF Mean Sx Mean Sz Mean Sx

Systolic

Both sexes 12-17 years ---------------

Blood pressure in mm. Hg

126.0

120.3

124.1

130.0

122.2

131.1

130.7

126.4

2.00

1.77

1.88

2.65

2.22

2.72

5.19

1.40

125.2

115.9

122.9

125.0

127.0

129.9

130.7

126.7

0.76

1.98

2.52

1.52

3.95

1.47

1.90

1.58

L27.5

119.5

127.0

126.8

128.6

131.5

132.7

129.5

0.68 126.9 2.61

3.39

4.11

6.11

;.;;

3:16

2.52

3.17

10.62

8.12

28.87

41.40

29.77

2.75

122.8

124.0

129.8

124.6

129.9

130.6

126.8

119.1

122.2

130.4

127.0

130.6

131.8

127.1

1.79

1.16

1.16

1.17

2.74

1.96

0.82

2.10

2.47

0.79

1.51

2.14

2.29

0.86

years-----------------------------------

years -----------------------------------

years--------------,---------------------

years -----------------------------------

years -----------------------------------

years -----------------------------------

Boys 12-17 years ---------------------

116.9

122.9

132.0

121.9

136.4

131.3

125.7

12

13

14

15

16

3.15

3.25

4.73

3.28

2.99

7.21

2.57

113.9

121.4

123.7

130.2

132.6

135.2

123.6

2.04

6.79

1.70

3.27

2.79

6.49

0.76

118.3

130.3

128.9

131.5

136.8

134.1

125.4

years -----------------------------------

years-----------------------------------

years -----------------------------------

years-----------------------------------

years-----------------------------------

years-----------------------------------

Girls 12-17 years--------------------

121.0

123.4

125.0

125.7

127.1

131.2

75.2

years-----------------------------------

years-----------------------------------

years-----------------------------------

years-----------------------------------

years-----------------------------------

years-----------------------------------

Diastolic

Both sexes 12-17 years ---------------

123.0

124.9

128.3

122.5

125.4

130.3

76.0

3.03

1.32

2.16

2.57

4.38

6.58

1.07

117.7

124.3

126.6

123.2

125.8

125.4

76.7

2.71

2.70

1.52

6.64

3.37

2.22

0.16

1.74

1.28

2.36

1.73

3.23

3.73

0.43

126.8

125.5

128.9

120.4

129.5

129.0

76.6

40.21

5.62

4.46

5.12

4.75

2.45

1.09

71.8

74.6

76.1

77.7

79.8

78.0

75.5

1.08

1.74

1.77

2.16

2.12

4.07

0.68

72.9

75.8

75.2

78.4

77.8

80.1

77.1

1.54

1.16

1.26

1.48

1.47

1.12

0.72

70.6

74.6

75.2

75.4

77.3

79.3

76.5

70.6

75.8

76.0

76.7

79.3

82.6

74.0

0.44

0.76

0.73

1.12

1.30

1.83

1.21

0.84

2.41

2.30

1.07

1.14

1.81

0.49

74.4

74.5

77.9

73.8

76.4

81.7

75.7

70.7

72.8

77.2

73.9

75.3

82.7

77.7

years-----------------------------------

years -----------------------------------

years -----------------------------------

years -----------------------------------

years -----------------------------------

years -----------------------------------

Boys 12-17 yeara ---------------------

1.13

2.86

1.34

2.51

2.33

1.06

1.30

2.41

7.31

1.62

16.88

;;.:;

.

1.23

12

13

14

15

16

years -----------------------------------

years -----------------------------------

years-----------------------------------

years -----------------------------------

years -----------------------------------

years -----------------------------------

Girls 12-17 years --------------------

70.1

73.3

75.0

77.5

82.3

77.3

76.3

2.22

2.05

0.83

1.56

2.65

2.99

1.70

71.9

74.2

75.1

79.4

78.9

81.5

76.2

3.16

2.87

1.94

0.99

2.74

3.77

0.88

73.1

75.5

77.0

77.8

77.1

78.3

1.57

2.07

2.28

2.86

2.40

5.83

73.7

77.4

75.3

77.2

76.1

78.4

1.19

1.50

0.65

2.68

2.64

1.54

70.5

73.3

74.5

74.1

75.6

75.6

0.66

2.27

1.03

1.45

1.60

2.13

78.3

76.0

78.8

;;.:

80:5

24.83

1.50

1.40

3.15

2.14

2.52

years -----------------------------------

years -----------------------------------

years -----------------------------------

years -----------------------------------

yeara-----------------------------------

yeara ...................................

NOTE: SE standard error of the mean. All blood pressures are the average of three readings.

25
diastolicblood pressures of youths 12-17 years by age,sex,and urban/rural

status: United States, 1966-1970

Table 8. Systolicand

Age and sex

Systolic Diastolic

Total II Urban I

Total Rura1

II Urban I

Rural

z .sX 3! Sz 27 SE

Blood pressure in mm. Hg

By~hl~exes

.

years--------- D.22 74.8

71.1

73.2

74.2

75.9

76.8

78.3

75.0

0.26

0.42

0.43

0.40

0.3C

0.49

0.33

0.3C

74.6

71.1

72.5

74.8

75.3

;;.:

74.4

128.5 0.27

121.8

126.0

128.6

130.3

132.4

132.9

130.3

0.32 128.2

121.2

126.1

128.4

130.2

131.8

132.4

130.1

0.38

0.56

0.43

0.56

0.47

0.73

0.49

0.36

129.1 0.39 74.7

71.1

73.0

;;.:

77:0

77.9

74.8

70.4

72.5

74.2

76.0

77.2

79.3

74.7

0.54

0.49

0.44

0.31

0.48

0.57

0.29

0.43

0.38

D.43

0.38

0.53

0.50

0.31

122.9

125.8

129.0

130.5

133.4

133.8

130.6

120.9

126.0

130.8

133.1

136.4

137.6

127.4

0.44

0.61

0.68

0.67

0.65

0.85

0.41

0.58

1.03

0.78

0.68

0.65

0.70

0.49

0.39

0.39

0.31

0.21

0.34

0.29

0.26

H

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

years-----------

years-----------

years-----------

years-----------

years-----------

years-----------

Boys 12-17

years---------

0.50

0.55

0.42

0.33

0.43

0.28

).23

1.42

).36

3.31

).26

2.40

2.46

70.4

73.0

74.0

76.3

77.4

80.1

74.6

71.8

73.5

74.4

75.4

;:.;

.

0.51

0.63

0.55

0.44

0.56

0.44

0.26

0.47

0.46

0.48

0.35

0.57

0.54

70.2

71.8

74.5

75.4

77.0

77.9

74.9

0.73

0.74

0.52

0.48

0.54

0.54

0.35

119.7

126.2

130.5

133.2

136.4

137.5

126.7

0.59

0.53

0.49

0.60

0.51

0.53

).40

119.0

126.3

130.3

133.3

136.4

137.4

126.3

0.73

0.56

0.66

0.78

0.70

0.77

0.48

years-----------

years-----------

years-----------

years-----------

years-----------

years-----------

Girls 12-17

years---------

72.0

73.4

75.2

75.2

77.8

76.6

0.73

0.45

0.56

0.43

0.58

0.79

124.0

125.9

126.7

127.3

128.3

128.3

1.48

3.51

1.60

3.43

3.74

!).73

123.5

126.0

126.4

127.0

127.6

127.6

0.60

0.70

0.85

0.55

1.01

0.81

124.9

125.6

127.2

127.9

129.6

129.7

0.68

0.66

0.73

0.82

1.03

1.37

71.8

73.5

74.7

75.3

76.7

76.6

years-----------

years-----------

years-----------

years-----------

years---=-------

years-----------

NOTE: All blood pressuresare the average of three readings;~= mean and SX. standard error

of the mean.

26
Table 9. systolic and diastolicblood pressures of youths 12-17 years by age, sex, and annual

familvincome.shown bv mean. standard deviation.standard error Of the mean, and median: United

State;. 1966--1970 - -

I

Annual family income IAnnual family income

less than $3,000 less than $5,000

Mean sx

Sx Median Mean s, Sx Median

Blood pressure,age, and sex

Systolic

Both sexes 12-17 years----

Blood pressure in mm. Hg

0.64

0.90

0.92

0.83

0.68

1.66

1.82

0.83

127.1

120.8

124.5

127.2

128.2

131.3

133.0

129.5

128.3

122.2

125.4

128.4

129.5

132.4

133.6

130.2

13.1

11.2

12.0

13.1

12.5

13.2

12.9

13.6

126.8

122.2

124.6

126.8

128.0

130.4

132.7

128.7

128.4

121.6

124.8

128.8

129.0

132.5

134.0

130.3

13.2

11.2

11.7

12.8

11.6

14.2

13.2

13.6

0.42

0.80

0.69

0.79

0.49

0.90

1.09

0.49

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

:2

17

12

;;

15

16

17

12

13

14

15

16

17

12

13

:;

:;

years------------------------

years-----------.-----.-=----

years-.......=---------------

years--.=--------------------

years------------------------

Boys 12-17 years------------

119.7

125.7

130.5

129.9

136.1

138.1

126.7

10.5

12.4

12.7

11.6

14.0

11.7

12.5

1.55

2.07

1.60

1.43

2.44

1.57

0.67

118.5

125.6

128.4

129.1

134.3

136.2

125.6

120.1

125.9

130.2

132.1

135.8

137.3

126.6

10.3

12.8

12.3

12.7

13.4

12.0

12.2

1.00

1.35

1.04

0.82

1.22

1.08

0.48

120.1

124.9

128.4

129.9

134.1

135.5

125.6

years ------------------------

years------------------------

years-----.------------=-=---

years------------------------

years------------------------

Girls 12-17 years-----------

122.9

124.1

127.3

128.1

129.6

128.8

75.5

11.6

11.1

12.7

11.5

13.8

13.3

8.7

~::

.

R

7.7

8.7

1.20

0.97

1.17

1.06

1.17

2.47

0.37

0.73

0.76

0.99

0.68

:.;;

0.70

122.7

124.3

126.5

126.4

126.8

127.3

74.5

71.1

72.4

74.5

74.6

76.7

78.7

75.0

124.1

124.9

126.9

127.2

128.5

129.0

74.9

71.4

72.9

74.7

75.7

;;.;

74.9

11.6

11.3

13.5

11.8

11.9

12.5

8.4

i::

8.2

8.2

7.7

7.7

8.5

1.06

0.53

0.99

0.73

0.80

1.47

0.21

0.65

0.37

0.45

0.35

0.42

0.55

0.38

124.0

124.4

126.0

124.8

126.3

128.0

74.0

70.6

71.9

74.0

74.7

76.3

78.2

74.1

years----.-=-----------------

years-.--.-..=---------------

years.-.-...----=--.--.-.-=--

jears-...-..--.----.-=-------

years------------------------

Diastolic

Both sexes 12-17 years----

71.9

73.3

75.8

75.7

77.7

78.8

75.7

~ears------------------------

years------------------------

years------------------------

~ears------------------------

Boys 12-17 years------------

70.7

74.7

75.6

74.3

78.1

80.0

75.3

1::?

8.2

8.5

7.2

7.1

8.6

1.24

2.06

1.23

0.67

1.02

1.00

0.47

69.9

73.2

74.8

74.0

78.8

79.6

74.2

70.2

72.5

74.3

75.3

77.6

79.5

74.9

7.1

9.6

;::

6.9

7.3

8.3

0.72

0.89

0.93

0.54

0.59

0.70

0.30

69.4

71.4

73.2

74.6

76.9

79.3

74.0

years------------------------

years------------------------

years------------------------

years------------------------

years-.-.-....-=-------------

years----..-.--------.=------

Girls 12-17 years-----------

72.8

72.2

75.9

77.0

77.4

77.4

0.76

1.27

1.33

0.80

0.86

1.51

71.9

71.4

74.4

75.9

75.9

75.4

72.4

73.3

75.1

76.1

76.6

77.3’

0.85

0.66

0.53

0.42

:.;:

.

71.9

72.2

74.2

74.8

75.7

75.6

years...-.----=---.-----=----

years------------------------

years.-.--.--w.=.-.---w------

years ------------------------

years---.....---=------------

See note at end of table.

27
Table 9. systolic and diastolic blood pressuresof youths 12-17 years

familyincome,shown by mean, standard deviation,

by age, sex, and annual

States, 1966-1970-Con.

standarderror of the mean, and median: United

Blood pressure,age, and sex

Annual family income

$5,000-$9,999

Mean 5X ‘~ Median

Annual family income $10,000

or more

Mean SX Sr Median

systolic

Both sexes 12-17 years----

Blood pressure in mm. Hg

128.7

121.5

126.6

129.2

130.5

132.4

133.8

130.3

119.3

126.7

131.4

133.8

135.7

137.8

127.0

13.1

11.7

12.1

12.2

12.7

12.9

13.3

14.0

10.9

13.0

12.5

11.5

13.6

13.0

11.8

0.43

0.72

0.77

0.46

0.60

0.80

0.73

0.44

0.82

0.98

0.45

0.74

1.03

0.99

0.51

127.2 128.4 12.6 0.47

0.67

0.96

0.60

0.69

0.64

0.91

0.60

1.25

1.12

0.81

1.19

0.77

1.37

0.47

126.8

120.1

124.9

126.2

130.3

131.7

129.9

128.8

:;:.;

128:3

133.0

136.8

136.8

125.0

12

13

120.3

125.4

121.8

125.7

128.2

130,4

132.8

132.0

11.2

11.8

11.7

11.4

12.9

years----.=.--.-----=.-.-..=-

years------------------------

years------------------------

years------------------------

years------------------------

years----.--.---.----..=-----

Boys 12-17 years------------

127.3

129.7

130.2

131.9 13.2

129.0 130.4 13.4

years ------------------------

years------------------------

years----...---.-.---.=------

years------------------------

years-..--=------------------

years------------------------

118.6

124.9

128.9

132.8

134.2

133.8

119.7

125.8

129.8

133.0

138.7

137.8

11.0

11.9

11.8

11.3

11.7

12.7

Girls 12-17 years----------- 126.1 126.4 11.5

124.1

126.6

127.0

127.1

128.6

129.1

74.6

70.8

;:.;

75:8

76.9

78.3

74.7

70.1

72.6

73.6

76.4

77.0

79.7

74.5

71.6

73.6

74.1

75.1

76.7

76.6

12.0

11.1

11.6

12.9

10.9

11.9

8.1

1.01

0.98

0.71

0.87

0.98

0.96

0.32

0.53

0.69

0.50

0.28

0.49

0.47

0.31

0.56

0.89

0.60

0.47

0.69

0.58

0.41

0.80

0.64

0.61

0.40

0.64

0.62

124.0

126.2

126.1

123.9

125.6

126.4

127.5

127.6

127.6

11.1

11.7

0.68

1.27

0.93

0.81

0.97

1.02

0.27

0.55

0.75

0.38

0.39

0.53

0.51

0.40

0.97

0.99

0.62

0.52

0.60

0.56

0.22

0.47

0.70

0.59

0.49

0.62

0.83

123.5

125.1

124.3

126.2

126.8

125.3

74.3

70.9

72.2

74.4

75.0

76.2

76.8

74.3

70.3

72.0

;:.;

76:5

78.4

74.2

71.7

72.5

74.6

74.6

75.9

75.4

years------------------------

years------------------------

years------------------------

years------------------------

years--=---------------------

years---.----..-.=--..----=-.

Diastolic

11.3

125.7

126.5

128.0

10.8

11.6

11.9

Both sexes 12-17 years---- 74.1 74.8 7.6

12 years------------------------

years------------------------

years---..--=----------------

years------------------------

years------------------------

years------------------------

7.5

;:;

;:;

7.8

8.4

7.0

7.9

7.9

::;

7.9

7.9

;:;

7.5

;::

7.3

70.3

72.6

73.2

;;.;

78:0

71.3

72.7

74.9

75.5

76.9

77.5

7.3

;:6

7.1

7.3

7.6

Boys 12-17 years------------ 74.2 74.8 7.6

years ------------------------

years ------------------------

years---w-----.--w-.=--------

;;.:

73;4

75.9

76.6

78.8

70.7

72.2

74.5

75.9

7.4

7.0

6.6

6.6

years------------------------

years------------------------

Girls 12-17 years-----------

77.5

79.0

74.1 74.8

71.8

73.4

75.5

75.0

76.5

76.3

7.6

12

13

14

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

70.9 7.L’

72.8

73.2

74.5

76.6

76.5

7.3

7.3

7.5

;::

15

16

17

NOTE: SX= standard deviation; Sx standarderror of the mean; all blood pressuresare the

average of three readings.

28.
Table 10. Systolic and diastolicblood pressures of white youths 12-17 years by age, sex, and annual family income, shown by mean, standard

United States, 1966-1970

deviation,standard error of the mean, and median:

Annual family income Annual family income

less than $3,000 less than $5,000

Mean s Sz x

Median Mean Sx ~ Median

Blood pressure, age, and sex

Systolic Blood pressure in mm. Hg

Both sexes 12-17 years---- 128.S 13.2

11.6

11.7

13.0

12.8

12.6

13.8

13.7

10.6

12.4

12.0

12.8

13.1

12.1

12.4

0.74

1.28

1.19

1.17

0.91

1.73

2.52

0.85

127.6

121.3

124.4

;;:.;

130:6

134.4

130.0

121.2

122.5

126.5

129.9

130.9

138.4

125.8

0.56

1.20

0.47

1.23

0.82

0.90

1.58

0.58

1.58

1.04

1.21

1.47

1.29

1.48

0.70

127.5

122.8

124.6

126.8

128.6

130.4.

133.8

129.5

122.0

122.8

128.5

132.0

132.4

136.8

126.3

128.5

122.2

124.6

127.8

130.1

131.7

135.2

130.6

13.1

11.8

10.5

12.2

11.7

13.2

14.7

13.4

12

13

14

15

16

17

123.C

125.4

128.7

130.6

132.7

134.4

130.9

121.6

124.7

130.2

134.c

134.9

139.2

127.1

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Boys 12-17 years------------

12 122.4

123.9

129.8

131.5

132.9

140.4

126.8

10.6

11.9

12.1

11.7

13.3

12.0

12.5

2.19

2.14

2.44

1.40

2.51

2.02

0.90

years------------------------

years------------------------

years------------------------

13

14

15

16 ~ears------------------------

17 years------------------------

Girls X2-17 years-----------

12

13

14

15

16

17

122.1

125.1

126.3

129.0

130.7

128.5

74.8

71.7

72.8

74.3

75.1

76.5

78.7

74.4

12.5

1;::

11.5

13.0

15.2

8.3

7.1

;:;

8.8

8.4

7.9

8.1

1.65

0.93

1.00

1.34

1.50

3.47

0.47

1.16

1.03

1.40

0.92

0.96

1.33

0.49

122.1

124.7

126.0

128.2

128.0

126.4

73.8

124.3

125.9

127.4

127.9

129.9

128.4

74.4

12.3

‘11.1

13.6

12.2

11.2

13.5

8.1

1.42

0.57

1.54

0.82

0.95

2.06

0.27

123.8

125.3

125.8

126.4

128.0

128.3

73.3

70.4

71.9

73.3

;;:;

77.0

73.0

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Diastolic

Both sexes 12-17 years----

12 71.0

72.3

73.7

73.4

75.8

78.3

73.5

71.1

72.5

74.0

75.3

76.4

77.8

74.2

0.90

0.42

0.62

0.46

0.51

0.63

0.45

years------------------------

years------------------------

years------------------------

years------------------------

~ears------------------------

Boys 12-17 years------------

70.8

73.3

73.4

73.1

76.3

79.0

75.0

2.28

1.54

1.67

1.16

1.12

1.43

0.72

70.3

72.7

73.0

72.2

76.1

79.1

74.0

70.1

71.6

73.1

74.9

76.5

78.5

74.6

7.2

8.3

;::

6.8

6.8

8.2

0.92

0.71

1.22

0.77

0.65

0.80

O*4O

69.5

70.9

72.2

74.1

75.0

78.5

73.6

12

13

14

15

years------------------------

years------------------------

years------------------------

16

17

~ears------------------------

years------------------------

Girls 12-17 years-----------

72.2

72.4

75.1

76.7

76.6

78.3

:::

8.9

8.5

9.3

9.2

1.06

1.20

2.05

0.94

1.55

2.07

71.7

71.6

;:.;

75:4

74.9

72.0

73.2

74.8

75.6

76.3

77.0

;:!

8.4

8.0

8.2

8.1

1.13

0.60

0.82

0.48

0.86

0.98

71.4

72.2

74.1

74.4

75.8

74.8

::

14

15

16

17

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

See note at end of table.

29
Table 10. Systolic and diastolicblood pressures of white youths 12-17 years by age, sex, and annual family income, shown by mean, standard deviation>standard error of the mean, and median:

United States, 1966-1970—Con.

Annual family income $10,000

or more

Annual family income

$5,000-$9,999

Blood pressure, age, and sex

Mean s, Sz Median Mean Sx + Median

Systolic Blood pressure in mm. Hg

Both sexes 12-17 years---- 129.1

121.8

126.8

129.5

131.2

132.7

134.2

130.8

13.2

11.7

12.1

12.4

12.6

13.1

13.3

14.1

0.47

0483

~.85

0.51

0.55

0.82

0.76

0.49

127.6

120.4

125.6

127.9

130.1

130.4

132.2

129.6

128.5

121.9

125.6

128.3

130.5

132.8

132.0

130.4

12.7 0.48 126.9

0.66

O*99

0.60

0.73

0.67

0.98

0.61

1.33

1.14

0.83

1.24

0.77

1.43

0.46

0.68

1.30

0.91

0.82

0.99

0.98

0.28

12

13

14

15

16

17

years------------------------

years------------------------

years------------------------

11.3

11.9

11.7

11.4

13.0

13.3

13.5

11.0

12.0

11.8

11.4

11.8

12.9

11.5

11.1

11.7

11.3

10.8

11.6

11.8

7.6

120.1

124.9

126.4

130.3

131.6

129.8

128.7

117.8

124.9

128.4

132.8

136.8

136.6

125.1

124.0

124.9

124.2

126.4

126.7

125.2

74.2

bears ------------------------

Boys 12-17 years------------

119.7

126.9

132.2

134.3

136.4

138.1

127.2

11.0

13.0

12.6

11.5

13.9

12.9

11.9

0.89

1.14

0.54

0.73

1.09

0.96

0.58

118.7

125.2

130.3

133.0

134.6

134.3

126.2

119.6

125.8

130.0

132.9

138.8

137.8

126.5

years ------------------------

years------------------------

bears------------------------

years------------------------

years------------------------

Girls 12-17 years-----------

12

13

124.5

126.6

126.8

127.8

128.6

129.4

74.5

70.6

72.7

73.9

75.9

76.8

78.3

74.6

70.0

72.2

73.8

76.3

76.9

79.7

74.4

12.0

11.1

11.6

12.9

10.8

12.2

8.2

7.5

;:;

8:3

7.9

8.4

7.0

7.9

;:;

8.4

7.9

8.0

1.18

1.10

0.76

0.84

0.93

1.02

0.35

0.57

0.72

0.53

0.29

0.47

0.47

0.33

0.59

0.93

0.62

0.48

0.77

0.60

0.44

124.3

126.2

126.2

126.0

126.6

128.1

74.0

124.1

125.4

126.5

127.7

127.6

127.5

74.7

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Diastolic

Both sexes 12-17 years----

12

13

14

15

16

17

70.2

72.3

73.0

75.2

76.6

77.9

74.1

71.2

72.6

74.9

75.5

77.0

77.3

74.7

;::

7.0

7.1

7.3

7*5

7.6

0.55

0.75

0.40

0.41

0.54

0.48

0.42

70.8

72.2

74.4

75.0

76.2

76.6

74.2

years------------------------

years------------------------

years------------------------

vears------------------------

~ears------------------------

years------------------------

Boys 12-17 years------------

7.4

7.0

6.6

6.7

7.0

7.5

7.6

70.3

72.0

74.0

75.3

76.5

78.3

74.2

69.4

71.9

73.1

75.8

76.6

78.7

74.0

70.6

72.1

74.4

75.9

77.4

78.8

74.8

1.01

1.02

0.64

0.54

0.63

0.60

0.24

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Girls 12-17 years-----------

71.2

73.2

73.9

75.4

76.8

76.5

70.6

72.6

73.0

74.9

76.6

76.4

71.8

73.3

75.5

75.0

76.6

76.2

7.2

7.3

7.4

7.5

7.6

7*3

0.46

0.71

0.58

0.56

0.61

0.71

71.7

72.5

74.6

74.5

76.0

75.2

8.0

8.0

7.6

::?

7..5

0.89

0.70

0.65

0.39

0.58

0.62

years------------------------

years------------------------

~ears------------------------

years------------------------

years------------------------

NOTE: s = standard deviation; 8E= standard error of the mean; all blood pressures

the averageXofthree readings.

are

30
Table 11. Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex, and annual

family income, shown byme~, standard deviation, standard error of the mean, end median: United

States, 1966-1970

Annual family income Annual family income

less than $3,000 less than $5,000

Mean Sx Sz Median Mean Sx SE Median

Blood pressure, age, and sex

systolic Blood pressure inmm. Hg

Both sexes 12-17 years---------- 127.0

120.4

125.2

127.9

126.8

131.7

131.8

128.7

12.8

10.1

12.6

13.3

11.3

14.7

10.8

13.6

1%:

12.9

11.7

13.7

11.0

11.7

10.0

11.4

13.2

10.5

12.9

10.3

8.9

l::?

8.3

8.0

k;

9.2

1.02 126.7 0.73 125.8

120.2

124.4

126.8

124.7

130.6

129.6

127.4

116.7

128.1

128.3

128.1

138.0

131.0

124.1

128.1

120.4

125.2

130.4

126.7

133.5

132.C

129.S

115.:

128.2

131.4

127.2

141.7

134.2

126.4

13.3

1?:?

13.6

11.1

15.8

10.1

13.9

120.3

125.1

128.5

123.7

134.5

129.5

128.8

1.32

1.86

0.75

1.14

1.84

1.46

0.88

1.60

3.27

1.39

1.22

1.80

1.47

0.71

12

13

14

15

16

17

1.51

1.57

1.26

1.36

2.42

2.03

1.49

1.27

3.86

1.83

2.00

2.93

2.36

0.83

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Boys 12-17 years----------------

1$::

13.3

11.0

13.5

10.0

12.5

114.2

127.5

129.2

126.4

143.4

131.8

125.2

117.2

127.7

130.3

128.4

138.3

133.3

125.4

123.8

122.8

125.9

124.8

125.9

130.2

76.0

71.9

73.8

76.3

76.8

78.8

79.9

76.4

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Girls 12-17 years---------------

1.98

1.28

1.37

2.00

1.57

2.35

0.48

124.0

121.4

126.2

122.4

123.0

127.8

75.3

124.8

122.7

129.1

126.1

127.7

129.3

76.7

72.4

74.1

78.0

77.0

80.0

79.1

77.7

70.7

76.8

;:.:

81:5

81.6

75.8

1:::

13.8

11.2

14.7

9.6

9.0

1::;

8.9

7.6

;::

9.2

1::;

7.8

7.7

R

8.8

1.96

1.86

2.79

2.10

2.37

2.83

0.73

125.1

120.8

126.7

122.5

125.1

127.5

76.1

71.2

72.6

76.8

76.3

80.1

79.4

76.9

68.6

75.5

79.0

75.0

82.0

79.9

74.8

74.4

70.8

75.6

76.9

76.7

76.1

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Diastolic

Both sexes 12-17 years----------

0.63

0.76

0.86

0.49

1.10

1.28

0.77

70.9

72.2

74.9

76.2

78.3

79.6

76.2

0.75

1.17

1.08

0.99

1.47

1.40

1.55

1.01

4.43

2.00

0.99

1.57

1.89

0.65

1.16

2.49

1.15

1.33

1.67

1.54

years------------------------------

years------------------------------

yeara------------------------------

years-----------------------------

years------------------------------

years------------------------------

BOYS 12-17 years----------------

6.7

11.4

7.9

8.4

6.4

7.9

8.5

0.74

2.03

1.66

0.61

1.24

1.40

0.60

69.6

72.3

76.3

76.0

81.0

80.4

74.6

70.6

74.2

76.8

76.1

80.6

81.8

75.7

years ------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

17 years------------------------------

Girls 12-17 years---------------

73.2

73.4

75.9

77.6

77.2

77.8

8.1

;.;

7:4

n’

1.04

1.85

0.79

1.12

1.14

1.41

73.0

72.1

74.5

76.4

;;.;

.

74.0

71.9

77.5

77.9

78.9

76.2

6.5

J::

7.5

H

years ------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

See note at end of table.

31
Table 11. Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex, and annual

family income, shown by mean, standard

States, 1966-1970—Con.

deviation, standard error of the mean, and median: United

Annual family income I

Annual family income $10,000

$5,000-$9,999 or more

Blood pressure, age, and sex

Meen Sx Sx Median

Systolic

Both sexes 12-17 years----------

Blood pressure in mm. Hg

125.8 11.8 0.70

1.55

2.00

1.83

2.20

1.54

1.79

0.85

2.08

3.05

2.15

2.82

2.48

4.29

0.79

2.58

2.84

1.89

2.18

2.97

2.28

0,44

125.1

118.7

124.1

124.3

125.6

128.0

130.0

125.6

116.3

122.5

121.3

130.3

130.0

132.2

124.8

120.4

126.1

126.0

124.4

126.3

126.8

74.7

127.7

119.9

129.0

122.5

128.7

129.6

135.1

129.6

11.5

10.0

1;::

1;.:

10:4

10.0

1.54

1.83

5.47

2.43

3.15

4.67

2.65

1.55

126.4

120.3

125.0

120.1

131.7

132.8

138.8

129.9

H

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

;:

14

15

;9

118.7

125.7

127.0

125.6

130.1

129.7

126,0

116.3

125,2

125.4

128.2

130.9

133.3

125.6

121.1

126.3

129.2

123.7

128.9

126.8

75.6

72.5

76.7

74.3

75.0

77.3

78.6

75.6

11.0

12.0

1:::

11.2

12.1

12.4

1%:

1?::

10.5

14.1

11.1

11.6

10.7

10.1

10.3

12.1

9.0

7.2

7.0

6.9

7.1

6.9

6.7

6.6

7.5

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Boys 12-17 years----------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Girls 12-17 years---------------

124.6

124.8

120.9

133.2

135.4

138.4

126.3

115.5

133.2

123.8

124.1

127.0

133.3

76.5

3.48

39.46

3.98

1.96

67.85

4.16

2.48

6.47

6.50

4.15

9.02

6.08

5.48

0,92

120.7

124.5

118.8

134.2

132.4

140.3

124.9

112.4

134.5

124.3

124.6

133.3

132.4

77.0

years ------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Diastolic

Both sexes 12-17 years----------

1;:;

11.9

11.8

10.0

11.3

8.0

1.01

1.09

1.67

1.02

1.31

1.47

0.68

71.7

75.9

74.2

72.3

76.6

78.8

74.7

71.4

76.7

75.5

76.4

76.0

81.5

78.3

6.8

5.6

::;

7.4

8.6

7.5

1.66

2.43

:.:;

3:05

3.06

0.91

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Boys 12-17 years----------------

70.7

80.3

76.5

76.6

77.1

84.7

78.7

70.4

76.1

73.2

77.2

78.4

80.4

75.6

74.6

77.4

75.9

73.5

75.7

77.0

Y!

7.2

6.0

5.8

6.9

6.9

6.6

6.5

;::

7.6

6,00

1.83

2.22

2.10

1.31

1.95

2.61

0.82

1.51

1.20

1.44

1.47

2.20

1.28

68.9

76.4

74.0

76.7

78.0

82.9

74.9

72.2

74.9

76.2

78.5

82.8

85.9

75.1

6.9

?::

4.4

4.8

3.6

8.1

2.55

24.06

2.54

1.85

41.42

1.93

1.66

70.6

70.7

78.2

80.3

84.6

85.3

74.9

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

Girls 12-17 years---------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

years------------------------------

72.9

75.7

75.1

71.4

76.5

76.7

70.7

78.6

75.0

74.3

73.0

79.1

:::

5.8

8.8

;:2

3.34

3.85

3.14

4.90

2.65

5.00

71.1

80.5

74.6

74.5

70.8

81.7

NOTE: S,= standard deviation; SX= standard error of the mean; all blood pressures are the average

of three reaaings.

32
Table 12. Systolic and diastolic blood pressures of youths 12-17 years by age, sex, and education

of parent shown by mean, standard deviation, standard error of the mean, and median: United

States.,1~66-1970

Education of parent Education of parent

less than 5 years 5-8 years

Blood pressure, age, and sex

Mean s

x %

Median Mean s Sz Median

x

Systolic Blood pressure in mm. I-&

Both sexes 12-17 years---- 129.0

122.0

125.7

128.9

130.7

132.7

134.2

130.6

13.2

12.1

12.1

11.7

12.9

13.0

13.3

14.3

128.5

121.8

127.2

129.9

129.5

131.8

131.8

130.5

12.6

10.7

11.7

13.2

11.1

14.4

11.1

13.4

10.6

12.7

14.2

10.9

14.1

8.9

11.4

10.5

10,7

12.0

11.2

10.8

12.1

8.3

6.7

10.1

8.9

7.5

:::

8.8

1::;

;.;

.

H

7.9

i:;

8.9

;:;

.

0.73 127.6 0.49

0.82

0.61

0.72

0.93

0.89

1.17

0.72

127.6

122.0

127.O

128.1

128.2

128.7

133.0

130.1

118.8

126.2

130.7

130.3

135.0

134.1

126.3

121.2

124.2

127.4

128.9

130.9

132.6

129.3

116.8

124.5

128.0

133.4

134.1

136.6

126.4

12

13

1.37

1.86

1.65

1.42

1.55

1.77

0.76

2.09

3.64

4.21

2.31

3.37

2.27

0.99

years ------------------------

yeara------------------------

years------------------------

years ------------------------

years ------------------------

years ------------------------

Boys 12-17 years ------------

14

15

16

17

120.4

126.2

133.2

130.5

138.2

135.2

126.5

123.2

128.0

;;;.;

124:5

126.7

75.2

71.7

74.9

74.0

75.0

77.5

78.9

75.2

70.5

75.0

73.6

73.7

77.9

80.0

75.2

72.8

74.9

74.2

76.3

77.0

77.2

117.9

126.1

129.9

134.8

135.7

138.7

127.4

10.5

12.8

11.5

12.5

13.3

13.5

11.9

1.20

0.85

1.08

1.02

1.16

1.54

0.52

years ------------------------

years ------------------------

years ------------------------

years ------------------------

years ------------------------

years------------------------

Girls 12-17 years -----------

2.64

1.82

1.15

2.53

1.87

3.21

0.81

125.2

129.4

126.6

127.2

122.9

127.9

74.3

125.5

125.4

127.8

127.2

129.4

129.3

75.1

12.3

11.3

11.7

12.3

11.9

11.2

8.2

1.05

1.19

0.91

0.91

1.16

1.48

0.37

125.8

124.1

126.7

125.4

128.2

127.8

74.4

;;.;

73:5

74.9

76.4

78.4

74.8

years------------------------

years------------------------

years ------------------------

years ------------------------

years ------------------------

years ------------------------

Diastolic

Both sexes 12-17 years----

71.4

73.3

72.6

73.9

76.7

79.2

73.8

71.4

73.0

74.4

76.1

76.8

79.1

75.3

0.66

0.63

0.64

0.44

0.46

0.65

0.41

12

13

1.04

1.93

1.43

1.60

1.13

1.71

1.24

0.90

4.81

3.76

1.57

1.74

1.70

0.61

1.83

2.02

0.99

1.98

0.78

2.63

7.4

8.3

7.4

i::

7.8

8.4

years ------------------------

yeara ------------------------

years ------------------------

years ------------------------

years ------------------------

years ------------------------

Boys 12-17 years ------------

12

13

70.9

72.9

72.0

72.3

77.1

79.9

74.6

70.4

72.6

73.6

77.2

77.1

80.2

75.0

:::

u

7.5

7.6

8.0

0.75

0.86

0.68

0.60

0.48

0.75

0.49

70.4

72.5

73.2

76.7

76.7

78.9

73.9

yeara ------------------------

years ------------------------

years ------------------------

years ------------------------

years ------------------------

years ------------------------

Girls 12-17 years-----------

72.0

74.1

73.0

76.3

76.5

78.4

72.2

73.4

75.2

75.1

76.5

77.9

8.2

8.1

7.2

::!

7.9

0.83

0.88

1.06

0.50

0.88

0.99

71.3

72.5

73.8

73.7

76.2

76.9

years ------------------------

yeara ------------------------

years ------------------------

years ------------------------

years ------------------------

years ------------------------

See note at end of table.

33
Table 12. Svstolic and diastolic blood Dressures of Youths 12-17 Years bv age. sex. and education

of parent> shown by mean, standard deviation,

States, 1966-1970-Con.

s~andard error-of the-me~n; and’median: United

I

Education of parent

9-12 years

Education of parent

13 years or more

Blood pressure, age, and sex

Mean 5X 5X Median Mean s. Sz Median

Systolic

Both sexes 12-17 years----

Blood pressure in mm. Hg

128.8

122.1

126.5

128.7

130.5

133.0

133.0

130.4

12.9

11.3

11.6

12.4

12.0

13.2

13.5

13.6

0.40

0.66

0.45

0.69

0.51

0.82

0.74

0.38

127.0 127.4 12.7 0.47

0.67

1.11

0.81

0.90

0.64

0.98

0.70

126.2

;;;.:

126:2

128.4

128.9

129.7

127.9

121.0

125.1

126.8

130.0

131.4

131.0

121.0

124.9

127.8

10.8

12.1

12.2

years ------------------------

bears------------------------

years ------------------------

years ------------------------

years------------------------

129.8 12.6

12.0

12.9

13i.o

131.7

Boys 12-17 years------------ 128.7 129.3 13.2

120.3

126.2

130.8

133.0

136.8

136.9

127.1

10.7

12.2

12.2

12.0

13.5

12.9

11.8

0.60

0.73

0.61

0.82

1.10

0.85

0.49

119.1

124.4

128.7

132.2

134.9

134.2

119.8

125.9

129.5

11.0

12.5

12.2

11.1

11.2

12.6

1.24

1.55

1.07

1.27

0.76

1.43

0.48

0.71

0.97

1.04

1.24

1.11

1.38

0.30

119.2

125.3

128.0

132.5

134,6

136,3

124.2

120.6

122.6

124,3

124.2

124.4

126.5

73.8

70.4

71.7

74.4

74,3

76.0

77.1

74.1

70.3

72.0

74.6

75.3

76.0

78.6

73.4

years------------------------

~ears------------------------

years------------------------

years------------------------

132.9

135.9

137.4

Girls 12-17 years ----------- 125.9 125.5 11.8

12 years---=--------------------

years------------------------

years------------------------

years.-----..................

years--------.--.=-----------

years--=---------------------

124.1

126.8

126.6

127.8

129.0

128.5

74.8

11.5

11.0

12.3

11.5

11.4

12.8

8.0

1.00

0.58

0.96

0.67

0.97

0.98

0.26

124.2

126.1

125.1

126.5

127.8

126.0

122.3

123.5

125.6

126.3

126.9

128.2

10.4

11.5

11.8

13.3

11.1

11.7

Diastolic

Both sexes 12-17 years---- 74.3 74.2 7.7

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years-----.--..-.---..--.-=-.

71.2

73.1

74.4

75.9

77.4

77.6

74.7

7.4

7.6

7.7

;:;

7.9

8.1

0.49

0.44

0.43

0.32

0.56

0.30

0.25

70.4

72.6

;;.;

76:8

76.6

70.6

72.1

74.7

74.9

76.5

77.4

7.4

(Z:;

7.7

7.2

7.1

0.55

0.78

0.47

0.56

0.48

0.57

0.47

1.00

1.04

0.73

0.81

0.79

0.81

0.30

Boys 12-17 years------------ 74.1 74.3 7.9

years------------------------

years------------------------

years------------------------

years-..-----..-=------------

years ------------------------

years------------------------

70.1

72.4

74.1

75.9

77,7

78.7

74.9

7.2

7.4

7.4

7.4

7.4

8.2

8.0

7.5

M

8.0

8.3

7.3

0.53

0.72

0.45

0,38

0.73

0.39

0.32

68.8

72.2

70.7

72.0

74.9

75.7

76.6

79.0

8.0

;:2

7.7

n

14

15

16

73.7

74.9

77.1

17 78.5

Girls 12-17 years----------- 74.5 74.1 7.3

72.3

73.8

74.7

75.8

77.1

76.3

years------------------------

years------------------------

years---’---------------------

years------------------------

years------------------------

years ------------------------

0.71

0.44

0.56

0.55

0.59

0.49

71.9

73.2

74.4

75.6

76.5

74.8

70.6

72.2

74.4

74.1

76.4

76.4

6.7

7.0

6.9

::;

7.1

0.56

0.71

0.59

0.78

0.59

0.61

70.6

71.6

74.2

72.5

75.9

76.2

NOTE: SX= standard deviation; SE= standard error of the mean; all blood pressures are the

average of three readings,

34
Table 13. Systolic and diastolic blood pressures of white vouths 12-17 years by

ucation of parent, shown by mean, standard deviation,

United States, 1966-1970

I

age, sex, and ed-

;tandard erro; of the mean, and median:

Education of parent Education of parent

less than 5 years 5-8 years

Mean S* SF Median Mean s, Sz Median

Blood pressure, age, and sex

Systolic Blood pressure in mu. Hg

Both sexes 12-17 years---- 129.1

~

13.3

12.2

12.3

11.6

13.2

12.9 ~

13.9

14.5

10.8

13.4

11.4

12.6

13.1

13.8

11.9

12.1

11.0

11.6

12.6

11.7

11.4

8.1

M

6.9

;::

.

8.3

M

6.8

8.8

u

.7.8

;::

6.8

6.9

8.7

7.6

0.55

0.86

0.66

0.77

1.13

0.81

1.47

0.90

127.9

122.3

124.1

;;;.;

131:0

132.4

129.8

129.1

122.7

126.4

130.4

130.5

133.4

133.3

131.3

12.0

10.3

1;::

10.9

13.1

10.4

12.6

1.00 128.3

1.71

1.36

2.73

1.87

2.43

2.67

0.86

L22.8

126.8

128.4

L28.5

130.4

133.8

130.5

122.4

125.9

128.5

131.1

133.1

134.1

131.0

118.2

125.6

129.6

135.5

136.3

139.6

127.4

125.5

126.2

127.4

127.8

129.6

128.1

74.8

71.2

72.8

73.9

76.1

76.6

78.5

75.0

70.2

72.5

73.1

77.2

76.7

79.7

74.7

12

13

14

15

16

17

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Boys 12-17 years----------

122.0

125.2

132.4

133.2

136.8

136.8

126.9

10.4

9.0

15.0

10.0

13.0

8.3

11.0

2.75

3.09

5.66

2.16

4.32

2.36

1.71

120.0

126.4

130.5

133.0

134.4

136.2

126.8

1.48

1.03

1.01

1.44

1.10

1.96

0.47

117.1

122.9

127.8

134.5

134.2

136.8

126.5

12

13

14

15

16

17

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Girls 12-17 years---------

4.32

1.64

2.29

3.02

3.34

4.63

1.00

1.52

1.90

2.04

2.00

1.37

2.75

1.25—

1.39

2.33

4.26

2.50

2.05

2.63

0.91

125.8

128.6

127.4

128.0

127.0

128.1

73.6

71.5

72.9

72.3

72.7

76.6

78.8

72.9

:.!33

1!10

1.00

1.18

1.65

0.43

126.5

124.6

126.5

125.7

128.4

127.0

74.2

12

H

15

16

17

123.3

127.1

128.8

127.9

127.2

128.0

74.4

10.2

9.5

12.5

11.0

10.8

11.0

7.8

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Diastolic

Both sexes 12-17 years----

0.75

0.63

0.74

0.56

0.52

0.74

0.49

0.69

0.96

0.69

0.68

0.53

0.92

0.56

70.6

72.3

73.2

75.1

76.4

78.1

74.6

70.3

72.4

73.0

77.5

76.5

78.8

73.6

12

H

15

16

17

71.2

73.5

73.0

74.1

;;.;

.

74.2

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Boys 12-17 years----------

12

13

14

15

16

17

70.4

72.2

71.9

73.2

76.8

80.0

74.5

5.8

::;

6.9

8.3

6.1

7.5

71.3

72.1

70.2

72.1

75.5

80.0

74.2

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Girls 12-17 years---------

2.89

2.23

1.38

2.13

1.24

3.64

0.98

0.77

1.24

0.61

0.99

1.04

70.9

72.3

73.3

74.0

76.2

76.5

12

13

14

15

16

17

71.9

74.3

73.9

74.9

77.4

76.8

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

See note at end of table.

35
Table 13. Systolicand diastolicblood pressures of white youths 12-17 years by age, sex, and education of parent, shown by mean, standard

~ited States,1966-1970—Con.

deviation,standard error of the mean, and median:

Education of parent Educationof parent

9-12 years 13 years or more

Mean s, s. Median Mean x

Sx SF Median

Blood pressure, age, and sex

Systolic

Both sexes 12-17 years----

Blood pressure in mm. Hg

129.2

122.7

126.8

129.1

131.3

133.2

133.3

130.9

12.9

11.4

11.8

12.4

12.0

13.2

13.6

13.6

10.7

12.2

12.2

12.0

13.8

12.8

11.9

0.45 127.6

122.1

125.3

126.9

130.4

131.5

131.8

129.0

127.5

120.8

124.9

128.0

130.1

131.0

131.9

129.4

12.8

10.9

12.0

12.2

12.6

12.2

13.0

13.3

0.48

0.69

1.13

0.81

0.94

0.65

0.98

0.71

126.2

119.4

124.8

126.4

128.8

128.4

129.7

128.0

12

13

14

15

16

17

0.74

0.54

0.79

0.54

0.78

0.77

0.44

years ------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Boys 12-17 years----------

120.8

126.2

131.5

133.7

137.0

137.4

127.5

0.62

0.88

0.73

0.89

1.03

0.74

0.54

119.6

124.2

129.0

132.6

134.9

134.7

126.3

124.6

126.5

125.1

127.0

128.1

126.0

74.2

119.5

126.0

129.9

132.9

136.3

137.9

125.6

11.1

12.3

12.1

11.2

11.5

12.7

11.8

1.31

1.64

1.07

1.32

0.84

1.54

0.50

118.4

125.6

128.2

132.4

134.9

137.1

124.2

years ------------------------

years ------------------------

years------------------------

years ------------------------

years------------------------

years------------------------

Girls 12-17 years---------

17

12 124.8

127.3

126.7

128.6

129.2

128.5

74.7

11.9

11.2

12,0

11.4

11.3

13.0

8.0

1.15

0.66

1.06

0.58

0.97

1.05

0.28

122.2

123.4

125.6

126.8

126.8

128.3

74.2

10.4

11.4

11.9

13.4

11.1

11.7

7.7

0.71

1.00

1.07

1.27

1.09

1.37

0.31

120.1

122.8

124.3

124.6

124.4

126.4

73.7

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Diastolic

13

14

15

16

17

Both sexes 12-17 years----

12 71.1

73.0

74.2

75.8

77.4

77.5

74.5

0.56

0.50

0.52

0.32

0.53

0.30

0.29

70.2

72.5

73.9

75.1

76.6

76.6

73.8

68.9

72.0

73.0

74.8

76.8

78.3

74.5

70.5

72.0

74.8

75.0

76.5

77.3

74.4

7.5

:::

7.8

7.3

7.1

7.9

0.57

0.79

0.47

0.58

0.52

0.53

0.48

70.4

71.7

74.4

74.4

;$:

.

74.1

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

Boys 12-17 years----------

13

14

15

16

17

12

13

70.0

72.2

73.8

75.8

77.4

78.5

75.0

7.1

7.4

7.4

7.1

;:;

8.1

0.55

0.76

0.53

0.42

0.78

0.46

0.34

70.7

71.8

75.1

75.7

76.6

78.8

74.1

8.0

7.5

6.7

7.7

::;

7.4

1.04

1.07

0.68

0.82

0.84

0.79

0.33

70.4

71.9

74.7

75.3

76.2

78.3

73.3

years------------------------

years------------------------

years ------------------------

years------------------------

years------------------------

years------------------------

Girls 12-17 years---------

72.3

73.7

74.6

75.9

77.3

76.4

0.81

0.53

0.64

0.56

0.57

0.57

71.6

73.0

74.4

75.7

76.6

74.9

70.3

72.2

74.3

74.2

76.4

76.4

6.7

::;

7.8

6.9

7.1

0.60

0.73

0.62

0.86

0.61

0.57

;;.;

74:1

72.5

75.6

76.2

12

13

14

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

NOTE: 8X= standard deviation; Sz= standard error of the mean; all blood pressures are the

average of three readings.

36
Table 14. Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex, and education of parent. shown by mean. standard deviation. standard error of the mean. and median:

United Stat&s, 1966-1970 -

Education of parent Education of parent

less than 5 years 5-8 years

Blood pressure, age, and sex

Mean 5X 5X Median Mean s, SE Median

Systolic

Both sexes 12-17 years----

Blood pressure in mm. Hg

127.1 1.33 126.2 128.2

119.6

128.6

128.7

127.0

129.1

128.6

128.8

13.6

11.3

14.8

11.2

11.1

15.9

11.8

15.0

10.3

16.0

1::;

16,2

9.0

12.0

12.8 0.90 127.1

12

13

14

15

16

17

H

14

15

16

17

12

13

14

15

:;

12

13

14

;2

17

12

13

14

15

16

17

12

13

i!!

16

17

years -----------------------

years ------------------------

years ------------------------

years------------------------

years------------------------

years------------------------

2.02

3.35

1.34

2.00

1.47

1.83

1.27

2.36

5.05

;.;;

3:92

4.41

1.61

119.5

128.5

126.6

123.4

126.0

129.4

129.0

116.4

125.6

138.4

120.2

146.0

129.6

124.9

120.1

125.1

131.2

129.1

130.0

135.0

128.9

116.8

127.8

131.4

132.7

132.0

135.6

127.4

125.0

122.0

130.9

123.9

128.1

134.3

76.6

12.0

11.6

11.7

12.1

13.7

10.5

13.2

1%:

12.2

12.0

14.5

11.8

12.4

13.9

12.2

11.2

10.3

1;.;

.

8.7

3.28

1.28

1.52

2.06

2.87

1.33

1.29

2.74

1.93

3.21

2.54

3.53

1.69

1.38

5.76

3.34

2.27

2.70

4.71

3.38

0.48

119.2

124.6

128.6

128.9

127.9

135.0

128.2

116.5

127.9

128.6

132.1

132.9

136.7

126.2

122.9

120.3

129.0

123.3

126.0

131.5

75.9

Boys 12-17 years------------

years------------------------

years------------------------

116.6

127.4

136.4

124.4

142.7

131.6

125.6

years------------------------

years------------------------

years ------------------------

Girls 12-17 years-----------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years..----.---.=--==..-.=.-.

122.9

130.0

125.9

130.0

122.2

124.2

77.0

11.3

13.1

10.6

11.4

10.3

13.9

9.2

2.99

4.50

1.78

3.92

1.81

4.80

1.42

124.3

131.9

125.8

127.1

119.7

126.5

76.4

Diastolic

Both sexes 12-17 years----

72.9

77.5

76.4

;;.;

79:2

77.5

1.65

3.62

1.30

1.89

1.53

1.15

2.60

years ------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years--=---------------------

6.9

13.2

9.1

8.5

;:;

10.1

70.7

74.0

73.4

78.3

77.0

79.6

76.9

72.3

74.3

77.6

76.2

78.2

81.6

76.5

1.10

1.32

0.90

0.64

1.25

1.74

0.46

71.0

74.2

78.6

74.6

78.1

81.6

75.8

70.7

73.6

77.8

76.1

78.7

79.8

76.0

Boys 12-17 years------------

years ------------------------

years------------------------

years------------------------

years ------------------------

years------=-----------------

years------------------------

70.9

78.5

80.6

74.9

81.2

80.1

76.5

1.21

7.65

:.::

2:57

2.07

0.58

70.0

74.0

79.7

74.4

81.8

79.8

76.1

71.3

73.1

77.1

77.2

79.7

82.9

76.6

6.3

7.8

8.0

;::

9.1

8.9

1.34

1.49

1.29

0.76

1.56

1.75

Girls 12-17 years----------- 0.92

75.1

76.3

74.9

80.2

76.7

77.8

7.9

10.4

9.7

::;

6.8

2.61

3.61

1.63

;.;;

2:38

71.9

75.1

70.9

78.8

75.0

78.7

73.8

75.6

78.1

74.9

76.8

80.4

9.7

9.1

8.5

7.9

;:;

2.49

1.93

1.69

1.36

1.74

2.81

73.7

74.6

79.5

72.5

75.5

82.1

years ------------------------

years------------------------

years------------------------

years------------------------

years------------------------

years------------------------

See note at end of table.

37
Table 14. Systolic and diastolic blood pressures of Negro youths 12-17 years by age, sex, and education of parent, shown by mean, standard deviation, standard error of the mean, and median:

united States, 1966-1970-Con.

Education of parent Education of parent

9-12 years 13 years or more

Mean S* SE Median Mean Sx SF Median

Blood pressure, age, and sex

Systolic Blood pressure in mm. Hg

Both sexes 12-17 years---- 125.9 12.1 0.57 L24.6 125.5 10.5 1.82 126.1

H

14

15

16

118.5

124.6

126.5

125.7

131.6

130.7

127.2

1;:;

12.5

10.3

12.6

12.4

12.8

0.87

1.18

2.07

1.45

2.44

2.25

0.84

1.63

3.25

2.06

1.73

3.44

3.10

0.85

L18.3

L24.1

L25.4

L24.6

L30.9

L27.7

L26.O

L15.4

L26.4

L25.7

L25.1

L34.9

L30.9

L23.7

123.5

124.4

121.6

118.9

131.9

130.0

126.2

124.9

122.9

118.8

129.5

131.8

129.3

124.7

12:

;::

6.6

5.7

10.0

1;:;

6:8

5.8

7.2

10.9

2.35

7.70

3.96

0.70

1.65

2.50

2.10

2.73

10.72

3,84

64.93

2.29

50.25

2.85

4.77

50.17

40.04

3.45

93.51

2.07

1.45

124.9

115.8

120.7

118.8

131.2

130.1

126.2

121.0

115.5

120.4

134.2

130.8

126.6

125.8

126.3

121.6

124.5

116.9

136.3

130.5

74.7

years------------------------

years--------------------=---

years------------=-----------

years----.=------------------

years ------------------------

years------------------------

Boys 12-17 years------------

12

13

116.5

125.9

127.1

127.3

135.2

133.0

124.7

10.2

12.2

11.2

10.5

11.4

13.0

11.2

~ears------------------------

years------------------------

years------------------------

years------------------------

years------------------------

14

15

16

17

Girls 12-17 years -----------

120.2

123.6

125.7

124.3

127.7

128.6

7.51.3

8.0

8.8

13.9

10.0

12.7

11.3

7.9

1.21

0.97

2.31

2.05

2.09

2.62

0.39

L19 .5

122.8

L25.2

L24 .3

L24 .4

L27.O

74.6

122.4

127.8

126.Q

114.6

132.3

130.7

75.4

11.9

12.9

5.3

6.9

8.2

3.7

6.9

years ------------------------

years------------------------

years------------------------

years------------------------

years ------------------------

years------------------------

Diastolic

Both sexes 12-17 years----

71.5

74.3

75.3

76.1

77.4

78.0

76.0

7.3

;::

8.8

8.0

7.6

8.3

::?

;::

6.4

7.1

7.5

0.69

1.16

0.66

0.99

1.59

1.52

0.45

1.26

1.84

1.13

0.69

1.75

1,96

0.94

71.2

74.2

74.6

76.1

;:.:

.

75.5

68.6

74.3

74.8

76.6

79.0

81.3

73.8

72.2

73.7

74.6

74.4

77.6

81.3

75.2

69.2

74.2

70.8

77.3

77.9

85.4

75.6

74.6

72.6

80.6

73.2

77.0

77.5

6.4

6.0

;:?

4.0

6.3

8.2

;.;

‘$;

4:6

2.4

5.0

i?:;

1.7

2.2

::;

2.53

4.66

4.12

1.45

2.83

4.81

1.68

4.37

6.72

5.75

38.87

3.10

33.08

1.52

2.15

28.13

25.52

1.36

54.44

4.83

72.0

71.6

78.1

73.2

76.6

82.5

74.6

68.4

70.9

74.2

81.2

74.9

84.4

74.8

74.2

71.7

79.5

73.0

77.3

78.5

years ------------------------

years------------------------

years ------------------------

years------------------------

years------------------------

years------------------------

14

15

16

17

Boys 12-17 years------------

12

13

14

15

years------------------------

years------------------------

years ------------------------

years ------------------------

years------------------------

years------------------------

70.5

74.2

75.3

77.1

79.5

80.6

74.6

16

Girls 12-17 years -----------

12

;;

15

16

17

72.5

74.4

75.3

75.3

75.1

75.6

1.38

1.31

0.66

1.47

2.15

1.74

72.6

74.1

74.4

74.8

73.6

73.1

years------------------------

years ------------------------

years------------------------

years------------------------

years------------------------

years ------------------------

NOTE; SX = standard deviation; SK= standard error of the mean; all blood pressures are the

average of three readings.

38
Table 15. Systolicand diastolicblood pressures

years by age and sex,

taken in the prone position of youths 12-17

shown by mean, standard deviation, standard error of the mean, and selected percentiles:United States, 1966-1970

Percentiles

5th 10th 25th 50th 75th 90th 95th

Blood pressure,age, and

sex

Systolic

Both sexes 12-17

years---------------

Blood pressure in mm. Hg

128.0 137.2 146.( 152.6

143.1

148.1

152.8

151.9

157.8

158.0

155.2

129.5

122.7

126.9

129.7

131.2

133.4

134.1

131.3

13.6

11.9

12.5

13.0

13.0

13.9

14.0

14.5

11.4

13.0

13.0

13.0

14.2

13.8

12.4

12.0

12.0

12.7

12.4

12.3

12.7

8.8

0.42

0.52

0.49

0.50

0.45

0.63

0.58

0.41

0.65

0.67

0.56

0.76

0.60

0.63

0.49

0.55

0.58

0.66

0.46

0.85

0.75

0.28

0.47

0.48

0.38

0.28

0.40

0.31

0.33

108.6 112.9 119.7

114.1

117.3

120.1

121.7

123.6

124.2

120.8

112.3

116.8

122.2

124.1

127.0

128.2

118.7

116.2

117.7

118.7

119.6

119.9

L20.O

67.2

64.1

65.3

67.0

68.0

69.8

71.0

66.9

63.1

64.5

66.8

68.3

69.9

72.1

67.5

64.8

66.5

67.3

67.6

69.8

69.8

103.9

107.6

109.3

111.6

112.8

113.7

108.8

101.9

107.3

111.7

113.9

116.4

118.2

108.4

105.5

107.9

108.1

109.0

110.5

111.0

58.6

55.1

55.8

59.4

60.8

61.2

62.5

58.2

54.8

55.5

59.5

60.4

62.1

64.2

59.0

55.5

56.6

59.4

61.1

60.2

62.1

107.6

111.1

114.0

115.4

116.9

116.8

113.3

106.1

110.6

114.9

117.2

120.5

123.3

112.5

109.9

111.8

112.3

113.8

115.0

114.1

61.8

58.4

60.1

61.9

63.3

65.0

66.1

61.5

57.9

5--.:

63:2

65.0

67.3

62.2

121.7

125.9

128.0

129.9

131.3

131.9

129.7

130.0

134.3

136.9

138.9

141.4

142.1

139.7

137.9

142.1

146.3

147.1

150.7

152.0

149.5

135.0

143.2

149.3

149.4

154.8

156.1

142.9

139.9

140.9

143.5

142.5

144.9

L45.5

83.9

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Boya 12-17 years-------

119.9

126.0

129.6

133.2

135.3

136.6

126.3

124.1

125.8

126.2

126.8

127.1

L28.2

72.8

69.2

70.9

72.3

73.8

74.7

76.0

72.6

67.9

70.4

72.1

74.0

74.9

77.1

73.0

69.9

71.4

72.6

73.6

74.6

75.0

126.7

134.7

138.6

142.3

146.3

146.2

134.6

139.6

150.7

154.3

154.2

161.4

163.5

148.8

12

13

14

15

16

17

120.5

127.0

131.6

134.2

137.4

138.6

127.7

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Girls 12-17 years------

132.5

133.9

134.3

134.7

135.9

136.6

78.5

145.0

145.4

149.3

148.0

151.0

152.1

87.0

12

13

14

::

17

125.0

126.8

127.7

128.2

129.3

L29.6

73.3

years-------------------

years-------------------

years-------------------

years------------y------

years-------------------

years-------------------

Diastolic

Both sexes 12-17

years---------------

74.3

76.4

77.9

79.4

80.6

81.4

78.6

73.2

75.7

77.5

79.6

80.9

82.2

78.4

75.0

77.0

78.5

79.1

80.3

80.2

79.4

81.4

82.9

84.3

85.5

86.0

83.7

78.0

80.6

82.5

84.4

85.0

87.0

84.1

82.3

85.6

86.2

87.8

89.1

89.6

86.9

81.6

84.4

85.6

87.9

87.9

90.2

87.0

12

13

14

15

16

17

69.5

71.4

73.0

74.2

75.7

76.8

73.2

8.3

;::

8.4

8.4

8.3

8.9

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Boys 12-17 years-------

12

13

14

15

16

17

68.5

70.8

72.7

74.3

75.8

77.7

73.5

8.0

8.9

8.0

8.5

8.3

8.3

8.6

0.57

0.69

0.49

0.42

0.47

0.29

0.28

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Girls 12-17 years------

12

13

14

15

:?

70.4

72.1

73.3

74.0

75.6

75.8

8.4

8.6

8.5

8.2

:.2

.

0.51

0.42

0.39

0.31

0.44

0.51

59.0

60.7

61.7

63.6

64.9

64.7

79.9

82.5

83.9

84.3

86.0

84.9

83.0

86.2

87.1

87.7

89.4

88.4

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

NOTE: SX=standard deviation;SX=standard error of the mean; all .oodpressuresare the average of the first two readings.

39
Table 16. Systolic and diastolic blood pressures taken in the prone position for Whi.. y:~~

12-17 years by age and sex, shown by mean, standard deviation, standard error of

and selected percentiles: United States, 1966-1970

2

Blood prX&s~x, age, TMean s

x

Percentiles

SF

5th 10th 25th 50th 75th 90th 95th

Svstolic Blood pressure in mm. Hg

Both sexes 12-17

years-------------- 0.48 108.8

104.2

107.9

109.6

112.5

114.0

113.5

108.9

103.1

107.6

111.9

115.1

117.0

119.0

108.7

105.8

108.3

108.1

110.0

111.4

111.2

58.6

54.8

55.6

59.6

60.6

61.0

62.4

58.1

54.4

55.4

59.8

60.2

61.9

63.3

59.0

55.4

56.3

59.4

61.0

60.5

62.2

113.2 120.0 128.3

122.2

125.9

128.1

130.5

131.4

132.5

130.0

137.5

130.6

134.4

137.0

139.3

141.5

142.6

140.1

127.4

134.7

138.8

143.2

146.7

146.5

134.8

132.9

134.0

134.3

134.9

136.0

136.4

78.2

146.9

138.4

142.1

146.2

147.7

151.3

152.6

150.2

153.2

143.6

148.3

153.0

152.6

158.0

158.1

155.6

140.1

150.4

155.1

154.6

161.5

165.3

149.2

145.0

145.4

;::.;

151:2

152.4

86.7

82.2

84.9

85.7

87.5

88.9

89.5

86.6

81.7

83.9

85.0

87.8

87.9

89.8

86.8

129.8

123.1

127.0

129.9

131.8

133.7

134.4

131.7

120.9

126.9

132.0

134.9

137.7

139.4

127.9

13.7

12.0

12.5

13.0

13.1

13.9

14.3

14.6

11.6

13.0

13.0

13.1

14.3

13.9

12.4

0.62

0.62

0.54

0.52

0.63

0.64

0.49

0.75

0.82

0.59

0.94

0.60

0.63

0.54

1.07.7

L1l.4

114.3

L.16.2

L17.4

L16.8

L13.6

114.3

117.3

120.4

122.5

123.9

124.1

121.2

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

H

14

15

16

17

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Boys 12-17 years----

L06.2

L1O.7

L15.5

L18.2

L21.4

‘.23.8

.12.9

112.6

116.7

123.0

124.5

127.1

128.6

1.19.O

120.2

125.8

129.9

133.7

135.6

137.4

126.6

124.5

126.0

126.3

127.3

127.4

127.6

72.6

69.2

70.6

72.2

73.7

74.6

75.9

72.4

135.8

143.2

149.7

150.2

155.4

156.8

L43.0

L40.2

L41.0

143.3

143.0

144.5

145.4

83.6

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17 years---

125.4

127.0

127.8

128.7

129.6

129.3

73.1

69.3

71.1

72.9

74.0

75.5

76.5

72.9

12.1

12.0

12.7

12.4

12.1

12.8

8.7

8.3

8.6

8.1

8.3

8.4

8.3

8.8

0.67

0.69

0.74

0.45

0.86

0.83

0.32

0.53

0.55

0.45

0.29

:.;;

.

0.37

.10.0

.12.2

.13.1

.14.5

.15.8

.13.9

61.7

58.3

59.9

62.0

63.0

65.1

65.9

61.4

57.6

59.4

62.2

63.0

65.0

67.0

62.0

L16.3

L17.8

L19.O

L20.3

L20.8

L19.4

67.1

64.0

65.2

66.9

68.0

69.8

70.8

66.7

62.8

64.4

66.6

68.3

69.5

71.7

67.5

64.7

66.4

67.2

67.6

70.1

69.8

years ------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Diastolic

Both sexes 12-17

years--------------

74.1

76.2

77.5

79.3

80.5

81.1

78.2

.—

72.9

75.4

77.1

79.4

80.7

81.9

78.2

79.2

81.2

82.6

84.2

85.5

85.8

83.4

77.9

80.1

82.1

84.2

L&;

.

83.9

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Boys 12-17 years----

68.4

70.4

72.5

74.1

75.5

77.4

8.1

8.5

7.8

8.4

8.5

8.3

8.6

0.62

0.77

0.53

0.47

:.;$

.

0.32

67.9

70.1

;;.;

74:7

77.0

72.9

69.8

71.1

;$.;

74:6

75.0

years------------------

years------------------

years------------------

years------------------

years------------------

years------------------

Girls 12-17 years---

12 years------------------

13 years------------------

14 years------------------

15 years------------------

16 years------------------

17 years------------------

l--73.3

8.3

8.6

8.4

8.2

8.4

8.2

0.60

0.47

0.48

0.33

0.41

0.48

59.0

60.5

61.7

63.1

65.2

64.7

7.4.8

76.9

78.2

79.2

80.2

79.8

79.7

82.1

83.5

84.2

86.0

84.8

82.8

85.9

86.5

87.1

89.2

88.6

70.2

71.8

73.2

74.0

75.6

75.6

NOTE : SX = standard deviation; sx=standard error of the mean; all blood pressures are the

average of the first two readings.

40
Table 17. systolic and diastolic blood pressures taken in the prone position for Negro youths

12-17 years by age and sex, shown by mean, standard deviation, standard error of the mean, and

selectedpercentiles:United States, 1966-1970

Blood pressure, age, and

sex TMean sx

Percentiles

Sz

5th 10th 25th 50th 75th 90th 95th

Svstolic Blood pressure in mm. Hg

Both sexes 12-17

years--------------- 127.6 13.1 107.6 111.c

106.3

109.8

112.3

111.8

113.C

118.3

111.4

126.3

119.4

125.7

126.8

126.1

130.2

131.2

127.9

135.4

127.1

133.9

136.5

;:;.$

139:2

136.8

144.8

134.2

142.2

146.4

142.6

149.5

148.0

146.4

149.2

139.7

146.7

149.4

146.8

153.8

152.6

150.7

0.62 117.5

112.6

116.5

118.4

116.6

119.5

124.8

118.2

120.4

126.3

128.4

127.4

131.3

132.9

128.6

11.1

12.5

12.8

11.9

14.3

11.8

13.6

0.86

0.80

1.22

1.23

1.85

1.55

0.67

101.6

106.2

108.8

109.2

109.9

114.6

107.8

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Boys 12-17 years-------

118.1

127.6

129.5

129.7

135.2

134.1

126.5

10.3

13.2

12.5

12.0

13.9

12.1

12.4

1.20

1.63

1.50

1.16

1.85

1.73

0.80

99.5

106.2

110.7

111.1

113.9

115.2

107.4

103.3

106.2

108.2

108.3

108.0

113.1

58.8

105.0

109.7

114.1

113.4

116.7

119.1

110.7

111.0

116.5

118.9

119.6

125.3

125.8

117.1

117.5

127.1

128.2

128.4

132.8

131.6

125.4

123.4

136.1

138.0

137.9

143.6

140.6

134.3

129.0

133.2

135.4

133.0

135.4

138.3

80.0

131.0

143.6

146.4

146.1

150.6

148.1

141.9

135.1

152.2

149.3

148.0

154.0

159.2

147.6

143.8

145.3

151.1

143.6

149.8

149.8

89.2

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Girls 12-17 years------

122.7

125.2

127.4

125.1

127.7

131.7

74.6

70.5

73.4

74.3

75.2

;:.;

.

74.8

69.3

73.2

74.4

75.8

77.8

80.1

74.3

11.4

11.7

13.0

11.3

13.6

11.5

9.1

;:;

8.7

~::

.

9.3

1$:;

::;

;::

9.0

1.26

0.73

1.64

1.71

2.26

2.42

0.33

107.7

109.8

110.8

110.0

110.9

118.2

62.8

58.6

61.5

61.8

64.8

64.4

67.6

62.6

58.8

58.1

62.0

64.2

67.2

69.5

62.9

57.8

62.7

61.7

65.5

62.6

65.1

114.6

116.5

117.0

115.6

117.0

123.8

67.9

121.9

124.9

125.9

123.0

125.3

130.7

74.1

69.6

73.0

73.4

74.4

76.6

78.0

74.4

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Diastolic

Both sexes 12-17

years---------------

136.1

140.0

146.6

139.9

147.3

146.8

85.0

0.44

0.56

0.52

0.72

0.99

1.39

0.62

0.68

1.55

1.21

0.82

1.10

1.51

0.69

56.1

57.2

59.3

61.4

61.4

64.4

58.6

56.3

56.5

59.3

61.2

63.1

68.0

59.1

65.0

66.5

68.2

68.4

70.3

72.8

68.0

64.8

64.9

:5.;

72:8

74.3

67.8

65.5

67.7

67.7

68.1

68.3

70.0

75.3

77.9

79.7

80.5

81.5

83.4

80.4

74.1

78.8

80.4

81.5

82.8

84.0

79.4

77.2

77.6

79.5

77.9

80.7

82.8

80.4

84.2

85.6

85.6

85.7

87.5

85.1

82.9

89.5

89.2

91.1

89.5

92.0

89.4

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

Boys 12-17 years-------

68.0

72.2

74.2

75.3

78.2

79.4

73.7

71.2

73.3

72.1

73.1

74.3

76.8

78.8

83.0

85.4

85.5

86.0

91.1

84.8

81.8

84.8

86.2

85.9

85.4

85.9

81.1

92.2

89.0

91.2

89.1

103.4

89.1

84.5

89.0

89.7

89.9

90.3

88.0

years-------------------

years-------------------

years-------------------

years-------------------

years-------------F -----

years-------------------

Girls 12-17 years------

71.8

73.7

;:.;

75:1

77.0

0.65

1.46

0.80

1.08

1.20

1.89

55.9

59.4

59.2

64.1

59.4

62.3

years-------------------

years-------------------

years-------------------

years-------------------

years-------------------

1 1 1

NOTE: S, = standard deviation; S5= standard error of the mean; all blood pressures are the

average of the first two readings.

41
Table 18. Systolic and diastolic blood pressures taken in the prone

age and sex,

position of youths 12-17 years by

shown by percent distribution: United States, 1966.1970

Boys Girls

I Blood pressure I I I I

inmm. H.g 12 13 14 15 16 17

years years years years years years

12 13 14 15 16 17

years years years years years years

Systolic

Total-------

I I I I I

Percent distribution

100.0 100.0 100.0

O.’i

12:!

31.5

27.6

13.6

8.0

::;

0.1

100.0

;.:

29:2

46.1

18.2

2.2

0.1

100.0

1:::

25.0

28.4

23.7

8.0

1.1

1.0

0.;

0.1

100.0

0.;

2::;

44.2

24.7

3.3

0.:

100.0 100.0 100.0

0.3

1.6

2::$

31.9

23.4

8.4

::5

100.0

::;

32.3

44.4

12.1

0.9

0.2

100.0

0.;

2!::

30.8

29.0

?::

0.4

o.i

100.0

0.:

3:::

44.5

16.9

1.6

0.4

100.0

O.i

12;

34.0

23.9

11.2

?:;

0.2

0.3

100.0

100.0 100.0 100.0

~dg 90----------

-------------

lo&lo9-----------

11o-119-----------

120-129-----------

130-139-----------

140-149-----------

150-159-----------

160-169-----------

170-179-----------

180-189-----------

190-199-----------

200 and over------

Diastolic

J::

28.4

32.8

15.3

4.7

0.6

0.4

100.0

O.i

2:::

28,7

25.8

10.3

5.3

::;

100.0

0.;

:::

24.5

27.8

21.5

12.3

3.8

H

0.2

0.2

100.0

0.;

2?:;

29.8

24.3

11.7

4.1

1.4

;:;

0.1

100.0

1;::

43.9

34.2

7.2

::$!

;:!

18.0

34.4

27.3

10.4

3.2

M

0.2

100.0

0.;

1;::

35.0

25.3

1:.;

0:8

0.7

0.1

100.0

1?::

49.6

2;.:

0:3

0.;

1::?

30.6

26.7

12.4

5.9

1.6

::;

100.0

1;:!

:;.:

.

H

0.2

-

Total-------

1::$

41.5

37.4

8.6

0.2

Under 40----------

40-49-------------

50-59-------------

60-69-------------

70-79-------------

80-89-------------

90-99-------------

1oo-1o9-----------

11o-119-----------

120 and wer------

.1.6

3:::

42.5

12.5

;:;

0.2

0.:

1;:;

46.2

27.9

4.2

0.2

0.2

::;

26.8

44.7

20.5

M

0.;

2;:;

44.8

2$:

.

NOTE: All blood pressures are the average of the first two readings.

42
Table 19. Systolic and diaatolic blood pressures .. of youths 12-17 years of all races by age and . . -..

sex for each of three separate readings, sh~

United States, 1966-1970

by mesn ana stanaara error or cne mean:

I I I

First I

First

systolic diastolic

Second

systolic

Second I

Third Third

diastolic systolic diastolic

Age and sex

I

Mean Sr I

Mean SX Mean Sg Mean %

Mean %Mean/ S.

x

Blood pressure in mm. Hg

Both sexes

12-17 years--- =2=== 131.8 0.23 I 77.6 0.18

:;;.:

131:9

133.5

135.6

136.6

133.7

122.9

129.2

134.0

136.7

140.0

141.5

129.8

127.2

128.9

129.8

130.2

131.2

131.6

0.32 127.2 0.36 72.0 0.27

0.47

0.50

0.43

0.31

0.38

0.24

0.34

126.5

120.0

124.3

126.S

128.5

130.4

130.5

128.4

118.2

124.4

128.1

131.4

134.5

135.-2

124.7

0.66 70.8

0.62 72.6

0.64 74.5

0.55 75.3

0.71 77.0

0.67 77.8

0.49

0.51

0.41

0.31

0.48

0.44

0.35

0.62

0.69

0.53

0.47

0.56

0.43

0.33

0.52

0.46

0.46

0,37

0.48

0.60

120.5

124.7

127.4

129.0

131.1

131.7

128.8

118.1

124.9

129.2

131.7

134.8

135.8

125.6

0.46

0.42

0.40

0.46

0.64

0.55

0.34

68.1

70.3

71.5

73.0

74.3

75.7

71.7

0.39

0.30

0.39

0.39

0.50

0.44

0.26

74.3

76.1

77.3

78.6

79.7

80.3

78.0

0.30

0.32

0.26

0.20

0.34

0.36

year8-------------

years -------------

years -------------

year8-------------

yeara -------------

yeare -------------

BOYS 12-17

years ----------- 0.21

0.80 69.9

0.83 72.0

0.72 74.7

0.93 75.9

0.74 77.3

0.79 78.8

0.60

0.56

0.49

0.64

0.59

0.58

0.44

67.2

69.6

70.7

72.7

74.2

76.6

72.4

0.57

0.75

0.51

0.42

0.45

0.35

0.28

0.57

0.49

0.49

0.46

0.51

0.47

0.31

74.0

76.0

77.1

79.3

80.3

82.3

77.2

0.43

0.43

0.39

0.33

0.50

0.44

yeara -------------

yeara -------------

yeara -------------

years -------------

years -------------

years -------------

Girle 12-17

yeara ----------- -1- 0.58 74.5 0.19

0.46

0.55

0.59

0.61

0.88

0.83

69.1

71.0

72.4

73.2

74.4

74.8

121.9

124.2

124.8

125.5

126.2

125.8

0.58

0.47

0.55

0.53

0.65

0.78

74.7

76.2

77.5

77.9

79.1

78.2

0.38

0.39

0.25

0.28

0.44

0.49

.

0.69 71.8

0.71 73.2

0.80 74.2

0.52 74.8

0.89 76.7

0.74 76.7

122.9

124.6

125.6

126.2

127.4

127.5

0.57

0.43

0.45

0.37

0.47

0.50

yeara -------------

years -------------

yeara -------------

years -------------

years -------------

year~.- . . . . . . . . . . .

NOTE: Sx = standard error of the mean.

43
Table 20. Systolicand diastolicblood pressures of white and Negro youths 12-17 years by age and

sex for each of three separate readings, shown by mean and standard error of the mean: United

States, 1966-1970

Race, age, and sex

Mean SF Mean 8X !lean %

Mean %

Mean Sr Mean SE

White

Both sexes

12-17 years---

years-------------

years-------------

years-------------

years-------------

years-------------

years-------------

BOYS 12-17

years-----------

years-------------

years-------------

years-------------

years-------------

years-------------

years-------------

Girls 12-17

years-----------

years-------------

years-------------

years-------------

years-------------

years-------------

years-------------

Negro

Both sexes

12-17 years---

years-------------

years-------------

years-------------

years-------------

years-------------

years-------------

BOYS 12-17

years-----------

years-------------

years-------------

years-------------

years-------------

years-------------

years-------------

Girls 12-17

years-----------

years-------------

years-------------

years-------------

years-------------

years-------------

years-------------

Blood pressure in mm. Hg

132.1 0.60 74.4 0.36 127.5 0.41 71.9 0.31 126.8 0.22 77.5 0.17

12

13

14

15

16

17

H

H

16

17

12

13

14

H

17

12

13

14

15

16

17

H

:;

16

17

12

13

14

15

16

17

125.5

129.1

132.2

134.1

136.0

136.9

134.2

0.77

0.74

0.68

0.64

0.75

0.72

0.62

70.6

72.2

74.3

75.2

76.8

77.5

74.4

0.56

0.58

0.47

0.33

0.49

0.38

0.38

120.8

124.8

127.6

129.5

131.4

131.8

129.1

0.54

0.54

0.44

0.50

0.62

0.65

0.39

67.9

70.0

71.4

72.9

74.2

75.5

71.4

0.52

0.57

0.49

0.33

0.41

0.28

0.39

120.3

124.4

126.6

129.1

130.4

130.8

128.6

0.38

0.30

0.41

0.46

0.46

0.47

0.24

74.3

75.9

77.1

78.6

79.6

80.1

77.9

0.32

0.32

0.28

0.25

0.35

0.39

0.22

123.4

129.1

134.4

137.5

140.4

142.4

130.0

127.6

129.1

129.9

130.7

131.5

131.3

129.6

121.9

128.8

130.5

129.2

133.5

134.8

130.4

0.89

1.00

0.74

1.14

0.81

0.78

0.63

0.85

0.82

0.85

0.61

0.90

0.83

0.64

0.86

0.82

1.59

1.19

1.82

1.63

0.63

69.8

71.6

74.5

75.7

77.0

78.6

74.3

71.5

72.8

74.1

74.6

76.7

76.5

75.9

71.6

75.0

76.0

76.5

77.9

79.5

76.2

0.68

0.80

0.57

0.52

0.59

0.46

0.38

0.62

0.48

0.55

0.40

0.49

0.61

0.29

0.57

0.78

0.44

0.76

1.10

1.66

0.59

118.4

124.8

129.5

132.2

135.1

136.3

125.9

123.2

124.9

125.7

126.8

127.7

127.3

125.6

118.9

123.9

126.3

125.6

129.2

130.9

126.8

0.71

0.69

0.53

0.80

0.56

0.61

0.49

0.54

0.66

0.70

0.53

0.90

0.93

0.71

0.99

0.95

0.97

1.40

1.93

1.59

0.83

67.0

69.2

70.5

72.5

74.0

76.2

72.4

68.8

70.8

72.3

73.3

74.5

74.7

73.2

69.4

71.9

72.5

73.8

74.8

77.6

73.5

0.61

0.79

0.57

0.47

0.57

0.41

0.31

0.65

0.51

0.53

0.41

0.43

0.46

0.40

0.41

0.72

0.72

0.72

1.07

1.17

0.68

118.5

124.3

128.3

131.8

134.4

135.7

124.9

122.2

124.5

124.8

126.3

126.2

125.9

125.0

118.0

123.7

125.9

124.8

130.0

128.9

126.8

0.62

0.39

0.41

0.57

0.43

0.49

0.32

74.0

75.7

76.9

79.3

80.0

82.0

77.2

;;.:

77:3

78.0

79.2

78.2

78.3

74.4

77.3

78.8

78.2

80.4

81.6

79.1

0.45

0.40

0.42

0.38

;.:;

.

0.18

0.40

0.42

0.30

0.36

0.45

0.46

0.42

0.66

0.59

0.62

0.59

1.02

1.20

0.75

1,00

1.39

0.98

0.56

1.61

1.30

0.65

1.17

1.01

0.67

1.28

1.16

1.84

0.58

0.57

0.65

0.60

0.65

0.79

0.80

1.19

1.39

1.22

1.26

1.65

1.38

0.98

119.7

129.8

131.4

131.2

137.3

135.4

128.7

124.2

127.9

129.6

127.3

129.8

134.3

1.16

1.64

1.71

1.27

1.91

2.03

0.88

70.3

74.2

76.8

77.0

79.6

80.6

75.7

73.0

75.7

75.2

76.0

76.3

78.4

0.52

1.22

1.31

0.83

1.44

2.03

0.65

i16.5

125.4

127.5

128.2

133.0

132.8

124.3

1.46

1.74

1.45

1.31

1.88

1.56

0.81

68.2

72.2

72.0

74.5

75.9

79.7

72.8

70.5

71.6

73.0

73.1

73.8

75.5

0.89

2.07

1.21

0.86

1.14

1.21

0.77

:.;;

0:68

1.03

1.38

1.91

216.3

125.2

127.4

127.8

134.8

132.2

123.2

119.8

122.3

124.4

121.8

125.4

125.8

1.40

2.66

1.61

1.31

1.73

1.66

0.82

1.61

0.80

1.30

1.71

1.91

2.25

73.6

77.6

78.8

79.1

82.7

84.6

77.5

75.3

77.1

78.9

77.4

78.2

78.7

1.35

0.60

1.17

1.88

2.36

2.41

1.27

1.14

2.18

1.78

2.23

2.58

0.96

1.71

1.09

1.21

1.11

2.12

121.3

122.4

125.2

122.9

125.6

129.0

NOTE: S.= standard error of the mean.

44 x
Table 21. Systolic and diastolic blood .pressures taken during Cycle II on those examined in both

Cycle II and Cycle III of the Health Examination Survey, shown by mean and standard error of

the mean

Time lapse from HES-11 to HES-111 for each examinee

Total

Less than 36-41 months 42-47 months More than

36 months 47 months

X2 s. Z2 %2 % %2 52 %2 $2 SX2

‘2

Blood pressure, age, and

sex in HES 111

Systolic

Both sexes 12-17 yearaBlood pressure in mm. Hg

112.1 0.24 112.1 0.81 111.8 0.41 u3.a 0.35

109.8

112.6

113.8

.

110.8

0.46 111.8

110.0

112.0

113.0

114.7

*

.

111.2

0.40

0.39

0.49

0.66

*

.

0.28

1.07

0.68

1.67

-

0.79

1.35

0.93

1.06

-

1.02

1.74

1.03

2.48

-

1.23

1.52

1.42

1.30

1.57

Z.06

L.69

L.31

.

.

.

L.07

!.62

!.22

..60

.

.

.

110.4

111.7

113.2

113.7

110.7

0.6C

0.4C

0.66

2.09

.

0.49

1#.;

U3:7

116.4

112.1

0.90

1.40

0.60

0.74

-

0.46

109.8

111.5

111.8

114.2

*

111.4

109.4

111.6

110.8

113.5

*

112.3

0.78

0.78

0.61

0.88

*

0.55

0.76

0.93

0.94

0.98

*

0.51

0.93

0.99

0.67

1.19

*

-

1.29

1.39

1.29

1.56

1.18

*

1.27

years....-...-----==-----

yeara--------------------

yeara --------------------

years--------------------

yeara--------------------

years --------------------

Boys 12-17 yeara --------

109.0

111.3

111.9

114.3

*

113.0

111.1

L12.8

114.1

115.1

*

67.3

67.4

67.6

67.0

67.2

*

67.1

66.7

67.3

66.7

68.3

*

67.5

109.6

110.5

111.5

113.8

-

112.9

111.0

112.8

115.0

113.7

68.4

68.6

68.3

68.2

68.6

67.9

67.8

67.9

68.1

68.0

68.8

108.1

112.4

113.0

116.6

113.8

112.8

112.7

114.2

116.2

67.3

66.8

67.8

67.2

67.2

-

66.6

0.88

0.71

0.45

0.96

0.73

years--------------------

years--------------------

years--------------------

0.38

0.43

0.57

0.74

*

0.39

0.61

0.61

0.71

0.85

*

.

0.55

0.59

0.70

0.65

0.78

*

-

0.61

0.79

0.78

0.65

0.94

*

.

CI.56

108.5

111.3

113.4

-

113.6

111.7

114.4

114.2

65.1

65.5

65.3

64.3

--

.

64.6

0.77

0.69

0.85

3.00

-

0.61

0.88

0.56

0.94

2.06

1.31

1.54

1.30

1.18

2.18

1.25

years--.--=--------------

years--------------------

-------------------Girls 12.17 yeara-------

yeara--------------------

years-------=.--------=-.

yeara.-w -----------------

years--------------------

years--..-.---...-.-.=---

yeara--------.---=-..=---

1.65

2.06

.0.93

1.10

0.64

0.40

1.71

0.52

0.86

-

1.02

1.44

1,87

1.38

1.40

0.38

110.2

111.5

113.1

114.9

*

67.9

68.0

68.7

68.1

67.0

*

68.2

Diaatolic

Both sexes 12-17 yearsyeara--------------------

years--------------------

years-..---..............

yeara--------------------

years--------------------

yeara--------------------

Boys 12-17 years--------

years--------------------

yeara ....=...=......=...-

years-......-..----------

years--.=----------------

years--------------------

yeara--.---.---=---------

65.3

64.7

63.7

65.5

1.75

1.39

0.86

2.54

1.43

65.6

68.4

65.1

67.6

67.8

67.7

68.7

67.9

68.6

*

.

67.6

1.42

1.36

1.56

1.31

*

1.37

1.81

1.38

1.70

1.16

*

Girls 12-17 years-------

yeara --------------------

years --------------------

yeara--------------------

years-..--...............

years-..-................

years...-...=.=---=------

68.1

67.9

67.4

66.0

*

.

2.69

3.67

1.82

3.89

*

.

65.9

66.1

64.8

-

.

.

69.3

68.8

68.2

69.0

.

1.41

1.28

1.74

2.55

.

.

68.1

67.4

68.7

66.7

.

.

1,29

1.71

0.86

1.17

.

.

68.2

68.7

68.3

65.0

*

.

NOTE: All blood pressures found in this table were taken in the prone position and are the average of two readings. The blood presaurea in this table are not population estimatea. d?q and

8X are mean and standard error of mean from the Health Examination Survey of 1963-65 (HES~II).

2

45
Table 22. Systolic and diastolic blood pressures taken during Cycle III on those examined in both

Cycle 11 and Cycle III of the Health Examination SurveX shown by mean and standard error of the

mean

Time lapse from HES-11 to HES-111 for each examinee

Total

Less than

36 months 36-41 months 42-47 months More than

47 months

33 8- -

X3

s= 33 Sx 33 8.-

‘3 53 8X

3 3 % 3

Blood pressure, age, and

sex in HES III

systolic Blood pressure in mm. Hg

Both sexes 12-17 years- 127.3

123.0

127.0

129.5

131.8

*

.

127.4

0.52 123.8

119.7

125.3

126.1

123.6

117.7

124.6

130.1

124.0

1.03 127.5

124.3

126.8

130.8

132.2

127.2

121.9

125.3

132.0

141.1

127.8

0.62 129.4 1.49

1.57

0.76

2.12

1.71

2.01

1.98

1.18

1.44

4.03

1.26

128.1

123.6

128.4

129.6

130.5

*

129.4

121.4

131.3

130.5

132.7

-Y

126.8

0.67

1.12

1.18

1.33

0.88

12

13

14

15

16

17

0.60

0.64

0.64

0.83

*

1.39

1.30

1.20

0.73

1.57

1.07

4.77

124.4

127.7

132.2

134.7

years --------------------

years--------------------

years --------------------

years --------------------

years --------------------

years --------------------

BOYS 12-17 years -------- 0.55 1.19

1.39

1.92

1.25

0.53 129.0 0.60

120.2

127.3

131.3

134.7

*

127.1

0.64

0.87

0.64

1.47

years-------------------- 0.92 119.8

years --------------------

years--------------------

years --------------------

years --------------------

years --------------------

Girls 12-17 years -------

1.13

2.01

1.78

0.95

*

1.39

1.56

9.66

128.6

133.5

137.8

17

0.60 1.46 1.05 129.7 0.96

H

14

15

16

17

125.8

126.7

127.8

128.9

*

71.9

122.6

126.2

123.1

69.6

2.08

1.60

1.99

126.6

128.2

129.3

126.0

71.5

years --------------------

years --------------------

years --------------------

years --------------------

years --------------------

years --------------------

Diastolic

Both sexes 12-17 years0.77

0.81

1.05

1.05

*

1.13

2.22

1.72

2.29

129.5

127.1

131.1

132.1

1.71

1.28

2.74

1.49

0.58

125.2

125.2

128.6

128.0

*

73.0

70.9

73.4

73.7

74.2

*

72.6

69.3

73.3

73.4

74.0

*

73.5

1.57

1.27

1.33

1.57

*

0.43 1.11 0.44 72.7 0.43

69.5

71.6

73.1

74.5

*

71.2

68.2

71.2

72.7

74*7

?.

72.5

0.61

0.58

0.46

0.52

66.6

70.6

71.7

-

68.6

66.0

69.6

70.7

70.8

1.44

1.34

0.88

69.4

70.9

73.6

75.3

70.9

68.4

70.0

73.3

77*5

72.0

0.74

:.;;

2:67

71.3

71.6

73.6

74.9

1.03

0.45

0.82

0.73

0.80

0.97

1.45

0.94

1.23

0.48

0.80

0.62

0.78

0.50

years --------------------

yeara --------------------

years --------------------

years--------------------

years --------------------

years --------------------

Boys 12-17 years --------

* *

17 .

0.55 1.58 0.52 72.2 0.37

12

13

14

15

16

17

years --------------------

years --------------------

years --------------------

years--------------------

years --------------------

years--------------------

Girls 12-17 years -------

0.70

0.84

0.66

0.7:

2.06

2.03

0.83

0.85

1.11

5.76

69.6

72.0

72.9

75.7

0.97

0.63

1.31

0.64

*

1.05

0.41 0.93 0.70 73.1 0.59

12

13

14

15

16

70.8

72.2

73.5

74.3

*

0.67

0.60

0.50

67.4

71.9

72.4

1.85

1.17

1.48

70.4

71.7

73.9

73.8

years --------------------

years--------------------

years --------------------

years--------------------

years--------------------

veals--------------------

0.93

1.42

1.07

1.63

73.2

71.2

74.0

74.3

1.60

0.60

1.14

0.43

72.1

73.5

73.9

74.4

*

:.;:

0:85

0.79

*

0.55

*

NOTE: All blood pressures found in this table were taken in the prone position and are the av.

erage of two readings. The blood pressures in this table are not population estimates. 33 and

%3 are mean and standard error of mean from the Health Examination Survey of 1966-70 (HES-III).

46
Table 23. Increase in mean systolic and mean diastolic blood pressures of those examined in both Cycle II and Cycle III of the

Health Examination Survey, shown by difference between means

Age and sex

in HEs III

Both sexes 12-17

year8-----------

12 yeara---------------

13 yeara--------------:

14 year8---------------

15 years---------------

16 years---------------

17 yearn---------------

Boys 12-17 years---

12 years---------------

---------------

i: ~.-- ......-...-.

15 years---------------

16 years---------------

17 years---------------

Girls 12-17 years--

12 years---------------

13 yeara---------------

14 yeara---------------

15 years---------------

16 years---------------

17 years---------------

Time lapse from HES-11 to HES-111 for each examinee

Total

Less than

36 months 36-41 months 42-47 months More than

47 months

systolic Diastolic systolic Diastolic Systolic Diastolic systolic Diastolic systolic Diastolic

33-52 53-32 53-52 33-52 2?3-32 53- Z* 53-B2 53-Z2. ~-32 33-52

Blood pressure in nm. Hg

15.2 4.6 11.7 4.5 15.7 3.1 16.4 5.4 16.3 5.1

13.0

15.0 ::;

13.9 0.s

12:?

14.1

:::

4.5

15.1

13.s

16.5 6.1 12.3

15.1

7.4

3.s 16.9

17.6 ;::

::;

17.1 7.:

1s.5 6.4 17.8

18.5

5.6

1s.3 7.7

*

16.3 7.2

* *

16.2 4.1 12.8 4.0 16.5 3.0 16.9 5.6 18.0 4.4

11.2 1.5 12.2 0.6

16.0

11.7

1?:: ?+:;

4.0 12.0

;;.;

14.8

::; 16.7

;:.:

7.0

3.6

20.5

19.7

$;

::;

6.4

19.7

27.3

“*

9.5 21:2 ;:! 19.2 5:$

* *

14.1 5.0 10.4 5.3 14.9 3.2 15.9 5.3 14.5 5.9

14.7 10.9 1.5

13.9

15.6

::;

1.1 16.7 5.1

11.8 5.8

15.0

13.7

15.4 14.4

5.9

13.7

7.6

N

13.s $3

14.3 ::; 16.9 ;:!

12.3

15.5

4.8

5.6

15.9

* *

13.1 9.4

* *

NOTE: 52 = mean fromHealth Examination Survey of 1963-65 (sSS-11), fi3- mean from Health Examination Survey of 1966-70 (HES-111),

47
APPENDIXES

CONTENTS

I.

IL

III.

I.

IL

III.

IV.

v.

VI.

VH.

Sources of Variation in the Measurement of Blood Pressure....................................................................

Exercise Tolerance Test .....................................................................................................................

Observer Differences ..........................................................................................................................

Venipuncture .....................................................................................................................................

End-Digit Preference ..........................................................................................................................

Statistical Notes ......................................................................................................................................

The Survey Design .............................................................................................................................

Reliability ..........................................................................................................................................

Sampling and Measurement Error ......................................................................................................

Tests of Significance ..........................................................................................................................

Tests of Normality .............................................................................................................................

Smafl Numbers ...................................................................................................................................

Demographic and Socioeconomic Terms .................................................................................................

LIST OF APPENDIX TABLES

Percent distribution of examinees 6-11 years and 12-17 years in the Health Examination Surveys of

1963-1965 and 1966-1970 by time of exercise tolerance test, according to age, race, and sex: He~th

Examination Surveys, 1963-1970 .........................................................................................................

Mean systolic and diastolic blood pressure levels and standard errors for exarninees 6-11 years and

12-17 years on the first and second reading b y time in relation to exercise tolerance test and sex:

Heafth Examination Surveys, 1963-1970 ..............................................................................................

Mean systolic blood pressure levels and percent of children and youths in relation to the exercise tolerance test procedure: Health Examination Surveys, 1963-1970 .............................................................

Number and percent distribution of exarninees in the Health Examination Surveys of 1963-1965 and

1966-1970 by age, sex, race, geographic region (youths only), and examining nurse.............................

Median blood pressures of children and youths by examinin g nurse: Health Examination Smveys,

1963-1965 and 1966-1970 ...................................................................................................................

Mean reading and nurse observer differences in blood pressure levels of youths 12-17 years by race,

geographic region, and sex: Health Examination Survey, 1966-1970 ...................................................O

Distribution of end-digit on blood pressure measurements by order of measurements among childxen

and youths: Health Examination Surveys, 1963-1965 and 1966-1970 .................................................

VHI. Sample of examinees and estimated U.S. population frequency dkribution of youths in the noninstitutional population of the United States, by race, age, and sex: Health Examination Survey, 1966-

1970 .................................................................................................................................. ...00000.,.00......

IX. Extent of missing and out-of-tolerance blood pressures by age and sex: Health Examination Survey,

1966-1970 ............................................................................................................................................

49

49

50

!;

56

56

57

58

59

59

60

61

50

51

52

52

53

54

55

58

59

48
SOURCES OF VARIATION

.

APPENDIX I

IN THE MEASUREMENT OF BLOOD

The three readily identifiable potential sources of

variation in the measurement of blood pressure existing

in two, but not all three, of the Health Examination Survey cycles are analyzed here to determine their impact, if any, on the levels obtained. These include the

exercise tolerance test in the examinations of children

and youths but not of adults, the venipuncture in the

examinations of adults and youths but not of children,

and the more limited number of observers in the examinations of children and youths than in those of adults.

Exercise Tolerance Test

Both the examinations of children and of youths

included an exercise tolerance test. 4’6 In the examinations of children the test consisted of a 2-

minute ride on a bicycle ergometer, and in the examination of youths the exercise consisted of a 5-

minute walk on a treadmill surface which was raised

to a 10-percent grade after an initial 2-minute period

of zero grade. 8

Among the children, blocd pressure was measured before exercise for more than half of the examinees

(S6 percent) compared with about one-third in the

youthsl study (36 percent) a& shown in table I. Four

percent of children compared with 0.6 percent of

youths had their first blood pressure measurement

within 20 minutes after exercise. The first blood

pressure level was determined 50 minutes or more

after exercise for only about one-fifth (19 percent)

of the children as compared with 50 percent of the

youths.

Among ;hildren, but not among youths, there was a

slightly larger proportion of the older examinees whose

pressures were read within 20 minutes after exercise.

Among children, no difference was found in the examination sequence between boys and girls. However,

among youths nearly twice as many girls as boys had

their blood pressure taken before the exercise tolerance test. No racial difference in examination sequence

is evident in either the examinations of children or

of youths.

The apparent magnitude of the effect of the exercise

tolerance test on the first systolic blood pressure

measurement varied with the time lapse between the

exercise tolerance test and that blood pressure measurement. Among both children and youths the mean

systolic pressure levels for those first measured

within 20 minutes after exercise were higher than

for those whose pressures were determined before

exercise or 20 minutes or more afterward (table

II). Among children, the first mean systolic pressure

for both boys and girls measured within 20 minutes

after exercise was 3 mm. Hg or more higher than

for those measured either before or 20 minutes or longer

after exercise, a difference large enough to be statistically significant at the 5-percent probability

level. While the youths measured within 20 minutes

after exercise showed an even greater elevation in

systolic pressure (mean difference of 7 mm. Hg)

than others, this group was so small that the elevation

could represent only a chance deviation. The pattern

of elevated first systolic pressure among this group

was generally consistent across the age range in

both studies, but the magnitude varied.

The apparent effect of the exercise on the second

systolic pressure is similar but slightly less than that

for the first reading, as would be expected since the

second was taken about 30 minutes after the first.

The diastolic blood pressure levels of children

and youths appear to have been unaffected by the time

lapse between the measurement and the exercise test.

As previously indicated, a substantial proportion

of children (56 percent) and youths (36 percent) took

the exercise test after their blood pressure had been

measured. The niean systolic levels for these examinees tended to be somewhat higher than levels

of those measured 30-40 minutes or more after exercise, although the mean differences are not large

enough to be statistically significant at the 5-percent

level. Since examinees in both surveys whose blood

pressures were taken before exercise had this procedure done within the first hour of the examination

while the rest were measured during the second and

third hours of the examination, the slight but consistent elevation in systolic pressure among this earlier

group may, if it is not just due to chance, be a reflection of some anxiety or apprehension among examinees during the earlier part of the examination.

“49
Table I. Percent distribution of examinees 6-11 years and 12-17 years in the Health Examination Survey@ of

1963-1965 and 1966-1970 by time of exercise tolerance teat, according to age, race, and aex: Health Examination Surveys, 1963-1970

I

Race

Negro

Ziiliiz

Time of blood

pressure measurement 10 I 11 +—r——+~

years yeara 6-11 12-17 I6-11 12-17

years years years yeara

Percent of examinees

100.0 1100.0 T

100.0 100.0

58.7 55.6

Total ----------- 100.0 100.0

54.4

2.2

10.0

11.4

J::

100.0 100.0 .00.0 100.0 100.0

51.6

1:::

8.9

1;::

100.0

34.2

0,3

:::

5!:;

Before exercise -------

After exercise:

Less than 20

minutes------------

20-29 minutes -------

30-39 minutes -------

40-49 minutes -------

50 minutes or more --

68.8

2.1

6.6

;:?

10.0

42.4

9.9

16.6

10.8

1?::

55.9

;.;

7:4

1::;

56.8 36.3

Age Sex

12

yeara

Time of blood

pressuremesaurement 13 14 15 16

years yeara years years

17

years

Percent of examinees

Total ----------- 11- ,00.0 100.0 100.0

25.3 56.4 47.9

100.0 I 100.o ]I.OO.o 1100.0 IIOO.OIIOO. O

I I I I i

1- !00.0 100.0

55.9 36.0

100.0

55.6

3.9

8.1

;:;

18.4

Before exercise ------- 32.2 34.0 36.9 36.1 “37.9 39.8

After exercise:

Less than 20

4.0 0.6

8.7 2.6

3.3

;::

18.7 5::;

minutea------------

20-29 minutes-------

30-39 minutes-------

40-49 minutes -------

50 minutes or more-.

H

M’

56.4

;.;

.

RI

19.0

0.4

1.7

1

Includes other racial groupa in addition to white and Negro.

In order to assess the net effect of the exercise those measured at least 50 minutes after exercise.

tolerance test upon the national estimates of systolic

blood pressure for children and youths, a comparison

can be made between the mean levels for those who

were presumably not affected by the exercise tolerance

test (bloal pressure determined 50 minutes or more

after exercise) and the mean for the rest of the examinees measured after exercise (table HI). Among

children the first systolic pressure mean is 1.3mm.

Hg higher and the second systolic 0.8mm. Hg higher,

with the average of the two readings among those

measured within 50 minutes after exercise elevated

by 1.0 mm. Hg above the levels for other children.

The apparent effect of the exercise is greater among

youths where the first mean pressure is 3.7 mm. Hg

higher and the second is 3.3 mm. Hg higher for an

average elevation of 3.5 mm. Hg above the levels of

Also apparent here, if the systolic pressure levels

obtained 50 minutes or more after exercise can

be considered the actual normal levels for these

groups of examinees, thechildren would seem to have

had their pressures elevated more by anxiety or apprehension during the initial part of the examination than

by the exercise test later (first mean of 112.0 mm. Hg

before exercise compared with 111.7 mm. Hg less than

50 minutes afterward) while the youths do show some

slight residual effect from exercise (table III).

Observer Differences

During the earlier examination survey of adults

two physicians were assigned to each examination

location, making possible the previously published

60
Table II. Mean systolicand diastolicblood pressure levelsand standarderrorsfor examinees6-11

yearsand 12-17yearaon the firstand secondreading by time in relationCO exercisetolerancetest

and sex:HealthExaminationSurveys,1963-1970

Firstblood pressuretaken Secondblood pressuretaken

After exercisetest Be- After exercisetest

Beforeexercise

test

A e, sex, and

b!oodpressure

20-29 30-39 40-49

min. min. min.

50

min.

or

more

exercise U;jer 20.29

test

min. min.

30-39 ~. 49 m;:

.

min. min. or

more

Under

20

min.

I I I 1

systolic Mean pressurein mm. Hg

Both sexes:

6-11 years-----

12-17years----

Boys:

6-11 years-----

12-17years----

Girls:

6-11 years-----

12-17years----

112.0

133.4

115.0

141.2

114.6

143.1

115.5

136.9

67.2

75.5

;;.;

.

67.4

69.9

0.58

3.50

0.76

4.58

0.89

4.90

0.72

2.23

0.99

2.26

0.83

2.83

112.2 110.9

134.5 134.7

109.8

133.6

109.2

134.9

110.6

130.5

67.6

74.9

67.8

75.0

67.4

74.9

110.4

129.9

108.8

128.3

111.2

130.3

109.9

131.3

112.4

128.0

:5.;

.

66.4

74.5

66.9

68.7

108.7

129.4

108.2

131.8

109.2

124.5

66.3

73.0

65.7

72.9

66.8

73.0

0.63

1.21

0.79

1.89

0.67

1.63

0.76

1.11

0.78

1.55

0.79

1.13

107.6

129.2

106.7

130.1

108.7

127.5

106.6

127.7

107.5

126.0

111

137

112

131

7

1

4

4

111.9 110.3

136.6 136.2

112.5 111.7

130.1 132.4

109.8

131.5

108.2

130.9

106.5

128.9

107.0

127.5

111.0

127.6

106.8

124.9

108.1

124.0

67.9 65.6

74.4 72.4

Diastolic

Both sexes:

6-11 years-----

12-17years----

Boys:

6-11 years-----

12-17years----

Girls:

6-11 years-----

12-17years----

Svstolic

67.4

74.6

67.3

74.9

67.6

74.5

0.29

0.64

0.39

0.69

0.35

0.65

0.61

0.36

0.63

0.44

0.62

0.36

68.0 67.9

74.4 75.6

67.5 68.0

74.8 75.8

;:.; 67.7

. 75.4

66.8

73.4

66.6

73.2

67.0

73.5

66.6

71.5

67.0

71.5

66.2

71.5

66.5

71.7

66.0

71.3

66.9

72.2

67.5

74.3

68.3

74.5

65.3

72.1

65.9

72.5

Standarderrorof mean

Both sexes:

6-11 years-----

12-17years----

Boys:

6-11 years-----

12-3.7years----

Girls:

0.68

0.82

0.80

0.87

0.99

1.37

0.47

0.37

0.53

1.51

0.68

1.76

0.65

2.30

0,89

1.20

0.88

1.28

0.97

1.36

0.79

1.28

0.85

1.37

1.09

2.06

0.69

0.97

0.63

1.28

1.03

1.12

0.60

0.93

0.81

1.08

0.92

1.15

0.73

0.58

0.80

0.58

1.01

0.80

0.43

0.52

0.54

0.53

0.48

0.67

0.64

0.31

0.65

0.34

0.70

0.37

0.32

0.44

0.36

0.64

0.37

0.46

0.59

0.30

0.61

0.47

0.61

0.35

0.49

2.51

0.60

2.61

0.80

5.04

0.70

1.84

1.19

1.56

0.79

3.44

0.83

1.02

1.05

1.29

0.93

1.22

0.56

0.35

0.47

0.54

6-11 yeara-----

12-17years----

Diastolic

Both sexes:

6-11 yeara-----

12-17years----

Boys:

6-11 years-----

12-17years----

Girls:

6-11 yeara-----

12-17years----

0.71

0.56

0.79

0.97

0.84

0.74

0.86

0.54

0.85

0.53

1.22

0.94

-

0.69

0.31

0.70

0.34

0.78

0.35

within-standpairedcomparisonsof bloodpressure the same nurse,one of thefournursesemployedin

levelsfrom thevariousexaminationlocationscontrolled

forageand sexdifferences.12

Blood pressure measurements in the examination

survey of youths, however, were obtainedby one of the

two nurses assigned to work at different examination

locations. In the previous examination survey of children, except for 12 percent of the children whowere

examinedat Locations with morethanonenursepresent,

all children at aparticular location were examinedby

thatprogram.

The percent distributionsof examinees in the

surveys of children and youths by age, sex, race,

geographic region (for youths only), and examining

nurse are shown in table IV. Among the nurses in

each of the surveys there are only small differences

in the distribution of examinees by age and sex and

larger differences in the distribution of children, but

not the youths,by race. The distributionf youths

51
Table III. Mean systolic blood pressure levels

and percent of children and youths in relation

to the exercise tolerance test procedure:Health

Examination Surveys, 1963-1970

First blood pressure

taken

All children (6-

11 years)-------

Before exercise--------

After exercise:

Under 50 minutes-----

50 minutes or more---

All youths (12-17

years)----------

Before exercise--------

After exercise:

Under 50 minutes-----

50 minutes or more---

Table IV. Number and percent distributionof examinees in the Health Examination Surveya of

1963-1965 and 1966-1970 by age, sex, race, geographic region (youths only), and examining

nurse

Percent

tlSystolic

of pressure

examinees First Second

Age, sex, race,

and region for

exsminees

Mean pressure in mm.

100.0

55.9

25.4

18.7

100.0

36.0

14.0

50.0

Hg

111.7

112.0

111.7

110.4

131.8

133.4

133.6

129.9

108.4

108.8

108.3

107.5

127.2

128.3

129.3

126.0

by geographic region for each nurse indicates adispropor~ionately small group in the West and Northeast

Regions examined by nurse2 who obtained the measurements for only one-third of the youth examinees.

Comparisons of differences in median systolic

blood pressure levels obtained by each nurse were

smaller among children (largest difference, 2.8 mm.

Hg) than youths (difference of 4.1 mm. Hg). (For this

comparison the children examined at locations where

more than one nurse was stationed, 12 percent, were

excluded.) The somewhat greater observer differences

in systolic pressure among youths will not have affected the analysis of the blood pressure levels of

youths by age, sex, or race because the distribution

of examinees for the two nurses in those respects

are similar (table V). However, it will have affected

and probably account for the regional systolic pressure differences since the nurse who obtained the

higher levels made very few of the measurements

among youths in the West Region, where themeansystolic pressures of youths were found to bethe loweat.

Median diastolic blood pressure levels of youths

obtained by the two nurses are in close agreement

(differenceof 1.6 mm. Hg) in contrast to the substantially poorer agreement among nurse observers

in the children’s survey where the maximumdifference

in median levels between nurses of 8.8 mm. Hgmay

have produced an underestimation of differences in

diastolic pressure levels between white and Negro

children.14

Those youths whose blood pressure was measured

bynursel(who made 69 percent ofsuch determinations

All examinees

6-11 years2---------

12-17 years---------

All examinees

6-11 years----------

12-17 years---------

Male

6-11 years----------

12-17 years---------

Female

6-11 yeara----------

12-17 years---------

White

6-11 years----------

12-17 years---------

Negro

6-11 years----------

12-17 years---------

Children

6-11 yeara----

6-7 years-----------

8-9 years-----------

10-11 years---------

Youths

12-17 years---

12-13 years---------

14-15 years---------

16-17 years---------

Geographic region

12-17 years---

Northeast-----------

Midwest-------------

south---------------

~est----------------

Nurse examinerl

Number

1,465 2,960 732 1,123

$,671 2,097 - -

Percent distribution

23.3

69.0

50.6

53.0

:;.$

.

79.8

86.4

20.2

13.6

100.0

33.0

34.1

32.9

100.0

35.2

34.7

30.1

100.0

27.4

22.1

18.3

32.2

47.1

31.0

52.3

51.0

47.7

49.0

89.7

82.5

10.3

17.5

00.0

32.9

33.6

33.5

00.0

36.0

33.3

30.7

00.0

17.3

34.6

4;.:

.

11.7

49.2

50.8

94.8

5.2

.00.0

32.9

32.7

34.4

17.9

50.4

-

49.6

84.8

.

15.2

100,0

32.7

35.4

32.0

.

-

.

-

l’fhenurse examinera in the two surveys were

all different individuals. zExc~udes the 83g children 6-11 years ex~~ed

at lc.cationswith more than one nurse.

in the 1966-70 Health Examination Survey) showed

consistently lower mean systolic and diastolic blood

pressures on the first two measurements and higher

on the third than the remaining 31 percent of youths

measured by nurse 2. The mean difference between

62
Table V. Median blood pressures of children and

youths by examining nurse: Health Examination

Surveys, 1963-1965 and 1966-1970

Blood pressure and

age of examinee

systolic

6-11 yeare----------

12-17 years---------

Diastolic

6-11 years----------

12-17 years---------

Nurse examinerl

1 2 3 4

Median pressure in mm. Hg2

110.2

128.3

60.5

72.8

108.4

132.4

69.3

74.4

111.21 110.4

. .

64.9 66.6

-11----

lThe nurse examiners in the two surveys were

all.different individuals.

‘First two readings in each survey with values

adjusted to age-race distributionofall examinees

in each survey.

those measured by the two nurses was greatest on

the first and least on the third blocd presaure determination. Youths observed by nurse 2 had mean

levels 5.3mm. Hg higher than those observed bynurse

1 on the first systolic reading and 3.1mm. Hghigher

for their second systolic reading but 1.1 mm. Hg

lower on their third (table VI). The mean age-sex

specific differences in the first systolic blood pressure levels of the youths measuredly the two nurses

ranged from 2.3 mm. Hg to 9.3 mm. Hgfor boysand

from 3.0 mm. Hg to 7.4 mm. Hg for girls, those measured by nurse 2 being consistently the higher.

The pattern of apparent nurse differences unobserved diastolic levels among these youths is similar

tothat for their systolic pressures but is less marked.

The mean diastolic pressures for youths measured by

nurse 2were2.1mm. Hghigherthanfor those measured

by nurse lonthefirst reading, l.lmm. Hg higher for

the second, but O.9mm. Hgloweronthe third. The agesex specific differences in diastolic levels for the youths

measured by the two nurses ranged from 0.9mm. Hg

to 3.1 mm. Hg for boys on the first reading and from

1.1 mm, Hg to 3.2 mm. Hg for the girls.

During the survey, replicate examinations, including a second set of blood pressure measurements,

were done by the original examiner 2t04 weeks after

the regular examinations among a sampleof302youths.

Of these 7 to 10 were from each of the examination

locations. The replicate blomi pressure readings were

consistently lower than the original readings by an

average of 3-5 mm. Hgfor systolic and 2mm. Hgfor

diastolic pressure. The pattern of decrease wassimilar for both nurses and one nurse replicated about

as well as the other. These lower replicate blood

pressure levels probably reflect the lessened concern

on the part of the youths because they knewwhatto

expect in the examination.

In the 1960-1962 Health Examination Survey of

adults, the physician observer differenceswere greater

than in either of the two subsequent surveys. Thedeviations of the mean blood pressure measurements of

each of the physicians from the mean forall physicians

(standardized on the basis of the age and sex of examinees) were as large as 17 mm. Hg for systolic and

12 mm. Hg for diastolic.

Although .the range of observer differences may

increase with an increase in the number of observers,

the mean values and distributions obtained under

standardized conditions may be expected to provide

a closer approximation tothetrue meananddistribution

in the population than those fromamorelimited number

of observers.

Venipuncture

A sample of blood was taken from every youth

between the first andsecond blood pressure readtigs.

Venipuncture and other parts of the examination could

have been viewed with anxiety by the youths, thereby

boosting the blood pressures of those who were most

anxious. Hence, the decrease in blood pressure with

time intheexamination mayreflect inpartthe decreased

anxiety about this procedure after venipuncture had

been taken. Itwasconcluded thatthevenipuncture in the

survey of adults where the timing of this procedure

varied had no effect upon the blood pressures.lz Presumably, the venipuncture was not a significant factor

in the youthst survey either.

End-Digit Preference

As in the two previous Health Examination Surveys,

the examiners in the survey of youths were instructed

to record blood pressures to the nearest 2 mm. Hg.

However, a number of odd digits were recorded with

“5” being the most common. On all systolic anddiastolic blood pressure readings for youths the “O” was

the most frequently occurring end-digit with both the

“2” and “8” being recorded less frequently than would

be expected by chance. This end-digit preference

among nurse observers is generally similar forchildren and youths (table VII) but is substantially less

than that shown by the physicians who measured the

blood pressure of adults in the 1960-1962 Health Examination Survey.12

53
Table VI. Mean reading and nurse observerdifferencesin blood pressure levels of youths 12-17

years by race, geographicregion, and sex: Health ExaminationSurvey, 1966-1970

Blood pressure

measure, race, and

sex

ALL YOUTHS

Systolic

Both sexes------

Boys------------------

Girls -----------------

Diastolic

Both sexes------

Boys------------------

Girls-----------------

WHITE

Systolic

Both sexes------

------- --------- --

%L-----------------

Diastolic

Both sexes------

Boys------------------

Girls -----------------

NEGRO

Systolic

Both sexes------

-------- -------- --

%:s-----------------

Diastolic

Both sexes------

Boys------------------

Girls-----------------

Nurse difference

(#2-i}l)

EEE

5.3

5.4

5.4

2.1

2.0

2.2

5.6

5.9

5.3

2.1

2.1

2.0

4.0

2.4

5.8

1.6

0.9

2.2

3.1

:::

1.1

1.3

1.0

3.4

2.9

3.9

1.3

1.6

1.1

2.1

-0.2

4.7

-0.3

-0.9

0.3

Reading differences

First-second Second-third

Nurse differences (#2-#1)

(mean of three readings)

I North- Mideast west South West

Mean pressure differencesin mm. Hg

-1.1

-1.5

-0.5

-0.9

-1.2

-0.8

-0.6

-0.9

-0.1

-0.8

-0.9

-0.7

-3.8

-5.1

-2.3

-2.1

-2.6

-1.3

3.9

4.1

3.7

2.2

2.7

1.7

4.0

4.3

3.7

2.2

:;7

3.3

::;

2.0

2.0

2.1

6.1

7.0

5.0

3.2

3.4

2.9

6.2

7.3

5.1

3.0

3.3

2.6

5.2

5.3

5.1

3.9

:::

-0,6

-0.7

-0.4

-6.2

-7.1

-5.4

-0.5

-0.6

-0.3

-6.3

-7.1

-5.4

-1.6

-1.6

-1.7

-5.8

-6.2

-5.4

3.6

U

-4.2

-4.6

-3.6

3.5

3.2

3.7

-4.2

-4.6

-3.6

4.3

;::

-4.0

-4.5

-3.8

4.7

U

0.7

0.2

1.2

---

---

---

---

---

---

---

---

..-

---

---

---

3.5

i::

2.7

3.0

2.3

---

---

---

---

---

---

---

---

---

---

---

---

1.4

-0.3

3.2

-0.5

-0.7

-0.4

---

---

-:-

---

---

---

---

---

---

---

---

---

3.4

U

‘1.3

1.5

,1.2

---

..-

---

---

...

---

---

---

..-

---

---

---

54
Table VII. Distribution of end-digit on blood pressure measurements by order of measurements

among children and youths: Health Examination Surveys, 1963-1965 and 1966-1970

Order of blood pressure

measurement

YOUTHS 12-17 YEARS

Systolic

First-----------------------

Second----------------------

Third-----------.-----------

Diastolic

First-----------------------

Second----------------------

Third-----------------------

CHILDREN 6-11 YEARS

Systolic

First-----------------------

Second----------------------

Diastolic

First-----------------------

Second----------------------

End-digit of blood pressure measurement

o 1 2 3 4 5 6 7 8 9 Hiss ing

1,617

1,655

1,655

2,506

2,504

2,214

1,759

1,724

1,756

1,856

1,311

1,172

1,140

761

727

717

1,442

1,375

1,319

1,240

1,490

1,493

1,520

1,289

1,294

1,220

1,534

1,490

1,216

1,212

14

10

12

19

1:

:

5

9

000

1,352

1,422

1,473

1,348

1,388

1,542

1,047

1,071

954

1,049

973

1,004

946

834

838

1,039

1,321

1,405

1,860

L,705

55
APPENDIX II

STATISTICAL NOTES

The Survey Design

The sample designs for the first three programs

or Cycles I-111 of the Health Examination Survey have

been essentially similar in that each has been a

multistage, stratified probability sample of clusters

of households in land-based segments. The successive

elements for this sample design are primary sampling

units, census enumeration district, segment (a cluster

of households), eligible persons, and finally the sample

person,

The 40 sample areas and segments utilized in

the design of Cycle III were the same as those in

Cycle H. Previous reports describe in detail the sample

design used for Cycle II and in addition discuss the

problems and considerations given to other types of

sampling frames, cluster versus random sampling,

and whether or not to control the selection of siblings?’6

Requirements and limitations placed on the design

for Cycle III, similar to those for children in Cycle

II, were that:

. The target population be defined as the civilian

noninstitutionalized population of the United States,

including Alaska and Hawaii, of ages 12-17 years

for Cycle 111, with the special exclusion of children residing on reservation lands of the American Indians because of operational problems

encountered on these lands in Cycle I.

● The time period of data collection be limited to

about 3 years for each cycle and the length of the

individual examination within the specially constructed mobile examination center be between 2

and 3 hours.

● Ancillary data be collected on specially designed

household, medical history, and school questionnaires and from birth certificate copies.

● Examination objectives be related primarily to

factors of physical and intellectual growth and

development.

●

66

The sample be sufficiently large to yield reliable findings within broad geographic regions

and population density groups as well as age,

sex, and limited socioeconomic groups for the

total sample.

The sample was drawn jointly with the LI,S, Bureau

of the Census starting with the 1960 decennial census

list of addresses and the nearly 1,900 primary sampling units (PSU’S) into which the entire United States

was divided. Each PSU is either a standard metropolitan statistical area, a county, or a group of two

or three contiguous counties. These PSU’S were grouped

into 40 strata, each stratum having an average size

of about 4.5 million persons, in such a manner as to

maximize the degree of homogeneity within strata

with regard to the population size of the PSU’S, degree

of urbanization, geographic proximity, and degree of

industrialization. The 40 strata were classified into

four broad geographic regions of 10 strata each and

then, within each region, were cross-classified by

four population density classes and classes of rate of

population change from 1950 to 1960. Using a modified

Goodman-Kish controlled-selection technique, one PSU

was drawn from each of the 40 strata.

Further stages of sampling within PSLPS required

first the selection of census enumeration districts

(ED’s). The ED’s are small well-defined areas of

about 250 housing units into which the entire Nation

was divided for the 1960 population census. Each ED

was assigned a “measure of size” equal to the rounded

whole number resulting from a “division by nine” of

the number of children aged 5-9 in the ED at the time

of the 1960 census. A sample of 20 ED’s in the sample

PSU were selected by systematic sampling with each

ED having a probability of selection proportional to the

population of children 5-9 years at the time of the 1960

census date. A further random selection by size of

segments (smaller clusters of housing units) within

each ED was then made.

Because of the 3-year time interval between Cycle

11 and Cycle III, the Cycle 111frame had to be supplemented for new construction and to compensate for segments where housing was partially or totally demolished

to make room for highway construction or urban redevelopment.

Advanced planning for the examinations at the

various locations or stands provided for about 17 days

of examinations which limited the number of examinees

per location to approximately 200. When the number of

eligible youths in the sample drawn for a particular

location exceeded this number, subsampling was done
by deleting from the master list of eligible youths

(ordered by segment, household order within segment,

and age within household) every nth name on the list

starting with the yth name, Y being a number between

1 and n selected randomly and n being the extent of

oversampling in the original draw.

In both Cycles H and 111twins who were deleted

in the sample selection were also scheduled for examination if time permitted, as were youths deleted

from the Cycle HI sample who had been examined in

Cycle II. The sample was selected in Cycles II and

111 to contain the correct proportion of youths from

families having only one eligible youth, two eligible

youths, and so on to be representative of the total

target population. However, since households were one

of the elements in the sample frame, the number of

related youths in the resultant sample is greater than

would come from a design which samples youths 12-17

years without regard to household. The resultant

estimated mean measurements or rates should be

unbiased but their sampling variability will be somewhat

greater than those from a more costly, time-consuming systematic sample design in which every kth Youth

would be selected.

The total probability sample for Cycle III included

7,514 youths representative of the approximately 22.7

million noninstitutionalized youths of 12-17 years in

the United States. The sample contained approximately

1,000 youths in each single year of age from 25

different States.

The response rate in Cycle 111was 90 percent,

with 6,768 youths examined out of the total sample.

These examinees were closely representative of those

in the samples as well as of the population from which

the samples were drawn with respect to age, sex, race,

geographic region, population density, and population

growth in area of residence. Hence it appears unlikely

that nonresponse could bias the findings appreciably.

Reliability

While measurement processes in the surveys were

carefully standardized and closely controlled, the correspondence between the real world and survey results

cannot be expected to be exact. Survey data are imperfect for three major reasons: Results are subject

to sampling error, the actual conduct of a survey

never agrees perfectly with the design, and the measurement processes themselves are inexact even though

standardized and controlled.

The first reports on Cycle 1115’6describe in detail

the faithfulness with which the sampling design was

carried out.

Dots recorded for each sample youth are inflated

in the estimation process t.o characterize the larger

universe of which the sample youth is representative.

The weights used in this inflation process are a

product of the reciprocal of the probability of selecting

the youth, an adjustment for nonresponse cases, and

a poststratified ratio adjustment which increases precision by bringing survey results into closer alignment

with known U.S. population figures by color and sex

within single years of-age 12 through 17 for the youths’

survey. It should also be noted that all of the blood

pressures in the findings sections of this report are

weighted to provide population estimates for the respective age groups in the noninstitutionalized population.

In Cycles H and 111 of the Health Examination

Survey the samples were the result of three principal

stages of selection—the single PSU from each stratum,

the 20 segments from each sample PSU, and the sample

youth from the eligible persons. The probability of

selecting an individual youth is the product of the

probability of selection at each stage.

Since the strata are roughly equal in population

size and a nearly equal number of sample youths were

examined in each of the sample PSU’S, the same design

is essentially self-weighting with respect to the target

population; that is, each youth 12-17 years of age had

about the same probability of being drawn into the

respective samples.

The adjustment upward for nonresponse is intended

to minimize the impact of nonresponse on final estimates by imputing to nonrespondents the characteristics of “similar” respondents. Here “similar”

respondents were judged to be examined youths in a

sample PSU having the same age in years and sex as

youths not examined in that sample PSU.

The poststratified ratio adjustment used in the third

cycle achieved most of the gains in precision which

would have been attained if the sample had been drawn

from a population stratified by age, color, and sex and

made the final sample estimates of population agree

exactly with independent controls prepared by the U.S.

Bureau of the Census for the U.S. noninstitutionalized

population as of March 9, 1968 (approximate midsurvey

point for Cycle HI), by color and sex for each single

year of age 12-17. The weights of every responding

sample youth in each of the 24 age, color, and sex

classes are adjusted upward or downward so that the

weighted total within the class equals the independent

population control for each survey.

Sample frequencies and estimated U.S. population

frequencies as of the approximate midsurvey point are

shown by age, sex, and race in table VIII. In addition

to youths not examined at all, there were some whose

examination was incomplete in one procedure or

another.

The extent of missing and out-of-tolerance blood

pressures is shown in table IX. Out-o~-tolerance

systolic blood pressures were those that were less

than 60 mm. Hg or more than 280 mm. Hg. Out-oftolerance diastolic blocd pressures were those that

were less than 35 mm. Hg or more than 150 mm. Hg.

Blood pressure values were imputed for those persons

57
Table VIII. Sample of examinees and estimated U.S. population frequency distribution of youths in

the noninstitutional population of the United States, by race, age, and sex: Health Examination

Survey, 1966-1970

Age and sex Total White Negro ::~

Both sexes I

Number of examinees Population in thousands

9,552

9,929

12-17 years --------------------- 6,768 3,024 116 3

), 047

540

542

527

525

496

417

?,688

999 34 !2,692

Boys

12-17 years --------------------- 3,545 479

101

80

88

%

69

520

19 .1,489 1,496 64

::

14

H

17

12

13

14

15

16

17

643

626 :

:

3

3

15

2,032

2,006

1,951

1,900

1,836

1,764

.1,203

1,747

1,729

1,686

1,646

1,594

1,528

9,623

280

262

256

241

231

225

1,527

1:

1?

11

11

53

years ------------------------------

years --------------------------- ---

years --------------------------- ---

years --------------------------- ---

years --------------------------- ---

years ------------------------------

618

613

556

489

Girls

12-17 years --------------------- 3,223

years --------------------------- ---

years ------------------------------

years ------------------------------

years --------------------------- ---

years --------------------------- ---

years ------------------------------

547

582

586

503

536

469

455

490

484

425

441

393

1,970

1,946

1,901

1,851

1,789

1,746

1,685

1,667

1,633

1,594

1,542

1,502

272

275

266

235

243

237

1:

2:

5

7

who had missing or out-of-tolerance blood pressures. it is not easy to find a Drocedure which will either

completely include both or treat one or the other

separately, the survey design and estimation procedure are complex and accordingly require computationally involved techniques for the calculation of

variances, and from the survey are coming thousands

of statistics, many for subclasses of the population for

which there are a small number of cases. Estimates

of sampling error are obtained from the sample data

and are themselves subject to sampling error which

may be large when the number of cases ina cellis

small or even occasionally when the number of cases

is substantial.

Estimates of approximate sampling variability for

selected statistics used in this report are included in

the detailed tables. These estimateshavebeenprepared

by a replication technique which yields overall variability through observation of variabilityamongrandom

subsamples of the total sample. The method reflects

both “pure” sampling variance and a part of the

measurement variance.

In accordance with usual practice, the interval

estimate for any statistic maybe considered the range

within one standard error of the tabulated statistic

with 68-percent confidence or the range within two

standard errorsofthe tabulatedstatistic with95-percent

If a youth was missing all blood pressures, the blood

pressures of a youth of the same age, sex, race,

height, weight, and upper arm girth were used asthe

best indicatorof the missingblood pressures. However,

if all of the blood pressures were not missing fora

particular youth, the blood pressures that were taken

and recorded were considered when themissingreading

was imputed.

Sampling and Measurement Error

In the present report, reference has been madeto

efforts to minimize bias and variability of measurement

techniques.

The probability design of the survey makes possible the calculation of sampling errors. The sampling

error is used here to determine how imprecise the

survey test results may be because they come from a

sample rather than from the measurements of all

elements in the universe.

The estimation of sampling errors fora studyof

the type of the Health Examination Survey is difficult

for at least three reasons: Measurement error and

“pure” sampling error are confounded in the data—
Table IX. Extent of missing and out-of-tolerance

tion Survey,

blood pressures by age and sex: Health Examina1966-1970

Age and sex

12

13

14

15

16

17

12

13

14

:2

17

Both sexes 12-17

years ------------

years ----------------

years ----------------

years ----------------

years ----------------

years ----------------

years ----------------

Boys 12-17 years----

years ----------------

years----------------

years ----------------

years ----------------

years ----------------

years ----------------

Girls 12-17 years---

years ----------------

years ----------------

years ----------------

years ----------------

years ----------------

years ----------------

Number First reading Second reading Third reading

of

persons systolic Diastolic systolic Diastolic Systolic Diastolic

19 5 8 7 7 11 14

; i 2 i 2

2

;

1

;

; :

3

0 ;

o : 1

:

4 3

:

3 3 : 3 i

8 1 2 2 2 5 6

: i ;

1

i

1

2

5 1 1

2

2

1 2

11 4 6 5 5 6 8

i

3 i

i

i

i

i

2

i

o 0

1

0

0

:

: 1

:

1

3

1

3 3

:

3 3 4

confidence. The latter is used as the level of significance in this report.

An approximation of the standard error ofadifference d_ x - y of two statistics x and y is given by

the formula Sd=(s:+s:)+ where SXand SYare the

sampling errors, respectively, of x andy. Of course,

where the two groups or measures are positively or

negatively correlated, this will give an overestimate

or underestimate, respectively, of the actual standard

error.

Tests of Significance

The procedure used in this report for testing the

significance of the difference between two means

consisted of dividing the difference between the two

means by the standard erfor of the difference as

computed above. In other words, a z- statistic was

computed. If the Z- statistic was greater than or equal

to 1.96, the difference was considered to be statistically significant at the 95-percent confidence level.

If more than one test is implied (such as, regional

differences—six implied tests) then the Bonferroni

test was used to test for significance. Inthe Bonferroni

test thez-statistic is also computed, but forthedifference between two means to be considered significant at the 95-percent confidence level, the ~statistic must be greater than or equal to 2.64 when six

tests are implied.

TestsofNormality

In this reporttheformulas usedtomeasure kurtosis

and skewness were those defined in the Statistical

Package for the Social Sciences (SPSS)~2Kurtosis is

defined as,the general peakedness of a distribution.

The formula is:

() Kurtosis = ‘N’=’ NW 4 -s

A positive value indicates that the distribution is more

peaked than the normal distribution, and a negative

value indicates that the distribution is flatter then the

normal distribution.

59
A skewed distribution is one that has a larger Small Numbers

number of cases in one tail of the distribution than in

the other. The formula is: In some tables magnitudes are shown for cells for

_2_&l

which the sample size is so small that the sampling

Skewness=~ J‘1 error may be several times as great as the statistic

N itself. Obviously in such instances the statistic has

no meaning in itself except to indicate that the true

A positive value indicates that the distribution is skewed quantity is small. Some such numbers have been

to the righq a negative value indicates that the dis- included in the belief that they may help to convey

tribution is skewed to the left. an impression of the overall story of the table.

60
APPENDIX 111

DEMOGRAPHIC AND SOCIOECONOMIC TERMS

Age. --’ rhe age recorded for each youth was the

age at last birthday on the date of examination. The age

criterion for inclusion in the sample used in this

survey was defined as age at time of interview. Since

the examination usually took place 2-4 weeks after

the interview, some of those who were 17 years old

at the time of interview became 18 years old by the

time of the examination. There were 23 such cases.

In the adjustment and weighting procedures used to

produce national estimates, these 23 were included

in the group 17 years old.

Race.— The race classification recorded by observation was confirmed by comparison with the race

classification on the youth’s birth certificate. Race

was recorded as “white,” “Negro,” or “other.” “Other”

races included American Indians, Chinese, Japanese,

and all races other than white or Negro. Mexican

persons were included with “white” unless definitely

known to be American Indian or of a race other than

white. Negroes and persons of mixed Negro and other

parentage were recorded as “Negro.”

Family income. —The income recorded was the

total income received during the past 12 months by

the head of the household and all other household

members related to the head by blood, marriage, or

adoption. This income was the gross cash income

(excluding pay in kind, e.g., meals, living quarters,

or supplies provided in place of cash wages) except

in the case of a family with its own farm or business,

in which case net income was recorded. Also included

in the family income figure were allotments and other

money received by the family from a member of the

Armed Forces whether he was living at home or not.

Education of head of household. —The highest

grade that had been completed in school was recorded.

The only grades counted were those that had been

completed in a regular graded school where persons

were given formal education, either public or private

school, either day or night school, and either fuUtime or part-time attendance. A regular school is one

that advances a person toward an elementary or high

school diploma or toward a college, university, or

professional school degree. Education in vocational,

trade, or business schools outside a regular school

system was not counted in determining the highest

grade of school completed.

Geographic Ye@”on.—For purposes of stratification

the United States was divided into four geographic

regions of approximately equal population. These regions, which correspond closely to those used by the

U.S. Bureau of the Census, were as follows:

Re@”on

Northeast -------

Midwest --------

South -----------

West ---------

States Included

Maine, Vermont, New Hampshire,

Massachusetts, Connecticut,

Rhode Island, New York, New

Jersey, and Pennsylvania

Ohio, Illinois, Indiana, Michigan,

Wisconsin, Minnesota, Iowa, and

Missouri

Delaware, Maryland, District of

Columbia, West Virginia, Virginia,

Kentucky, Tennessee, North Carolina, South Carolina, Georgia,

Florida, Alabama, Mississippi,

Louisiana, and Arkansas

Washington, Oregon, California,

Nevada, New Mexico, Arizona,

Texas, Oklahoma, Kansas,

Nebraska, North Dakota, South

Dakota, Idaho, Utah, Colorado,

Montana, Wyoming, Alaska, and

Hawaii

Urban or rural aveas. —The definition of urban

areas was the same as that used in the 1960 census.

According to this definition, the urban population was

comprised of all persons living in (a) places of 2,500

inhabitants or more incorporated as cities, boroughs,

villages, and towns (except towns in New England,

New York, and Wisconsin); (b) the densely settled

urban fringe, whether incorporated or unincorporated,

of urbanized areas; (c) towns in New England and townships in New Jersey and Pennsylvania which contained no incorporated municipalities as subdivisions

and had either 2,500 inhabitants or more, or a population of 2,500 to 25,000 and a density of 1,500 persons

or more per square mile; (d) counties in States other

61
than the New England States, New Jersey, and Penn- any urban fringe. The remaining areas were classylvania that had no incorporated municipalities within sified as rural.

their boundaries and had a density of 1,500 persons Urban areas are further classified by population

or more per square mile; and (e) unincorporated size for places within urbanized areas and other urban

places of 2,500 inhabitants or more not included in places outside urbanized areas.

000

*U.S. GOVERNMENT PRINGING OFFICE 1977- 241.lSOZI

62
series 1.

Sera”es2.

Series 3.

Series 4.

Sert”es10.

Sera”es11.

Sera”es12.

VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly &blic Health Service Publication No. 1000

Programs and Collection hocedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and

other material necessary for understanding the data.

Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques,

objective evaluations of reliability of collected data, contributions to statistical theory.

Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised birth

and death certificates.

Data from the ‘Health Interview Survey.-Statistics on illness; accidental injuries; disability; use of

hospital, medicd, dental, and other services; and other health-related topics, based on data collected in

a continuing national household ititerview survey.

Data from the Health Examination Survey.-Data from direct examination, testing, and measurement

of national samples of the civilian, noninstitutionalized population provide the basis for two types of

reports: (1) estimates of the medically defiied prevalence of specific diseases in the United States and

the distribution of the population with respect to physical, physiological, and psychological characteristics; snd (2) analysis of relationships among the various measurements without reference to an

explicit fiiite universe of persons.

Data j+om the Znstt”tutz”onalized Population Surveys. –Discontinued effective 1975. Future remxts from

these surveys will be in Series 13.

.

Sera”es13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities ●

providing long-term care, ambulatory care, hospital care, and family planning services.

Sert”es14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities.

Sert”es20. Data on Mortality. –Various statistics on mortalit y other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records, based on

sample surveys of those records.

Sera”es21. Data On iYatality, Mam”age, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records, based on sample surveys of those records.

Series 22. Data from the National Mortutity and Natality Surveys. –Discontinued effective 1975. Future reports

~om these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Sera”es23. Data j%om the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey of

a nationwide probability sample of ever-married women 1544 years of age.

FOEa list of titles of reports published in these series, write to: Scientific and Technical Information Branch .

National Center for Heslth Statistics

Public Health Service, HRA

Rockville, Md. 20857

/-’”