Ambulatory Blood Pressure Monitoring in Children and Adolescents: a Review of Recent Literature and New Guidelines

Abstract

Recent data has shown that ABPM is more strongly associated with end-organ damage than casual BP, and that obesity and secondary causes of hypertension are strongly associated with nocturnal hypertension. There is evidence that ABPM is useful in management of a larger variety of diagnoses than previously thought. New guidelines from the American Academy of Pediatrics recognize the importance of ABPM in the management of pediatric hypertension. ABPM has an important and growing role in the diagnosis and management of hypertension in children and adolescents. Future efforts should include developing more generalizable normative data and investigating associations between pediatric ABPM results and adult outcomes.

Monitorización Ambulatoria de Presión Arterial (MAPA): recomendaciones de la rama de nefrología pediátrica

“…Los hábitos de vida saludable tendrían un impacto en la disminución de su prevalencia. Así mismo los niños obesos presentan una mayor prevalencia de este tipo de HTA 17,18 . En adultos la tendencia actual es iniciar tratamiento antihipertensivo dado que la HTA enmascarada sería un importante factor de riesgo cardiovascular 19,20,21 .…”

“…Es un patrón dentro de MAPA que se ha asociado con la presencia de obesidad, síndrome de apnea osbtructiva del sueño y resistencia a la insulina. En población adulta se relaciona a peor evolución cardiovascular 18 . En pediatría existen estudios que no han logrado demostrar su asociación con HVI 22,31 .…”

“…Sin embargo, esta clasificación deja un grupo importante de pacientes que no calzan en ningún diagnóstico preciso, de acuerdo a las recomendaciones expuestas en la tabla N°3. Estos pacientes deben ser evaluados caso a caso y clasificados de acuerdo con sus factores de riesgo cardiovascular individuales 18 .…”

Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension

“…As in adults, ambulatory blood pressure (BP) measurements are more accurate than office BP for the diagnosis of HTN in children and adolescents,[8, 9] and correlate more strongly with cardiovascular hypertensive TOD. [1, 9-12] Furthermore, increases in short-term and long-term BP variability have been associated with TOD, including decreased cognitive function, in hypertensive adults.…”

“…As in adults, ambulatory blood pressure (BP) measurements are more accurate than office BP for the diagnosis of HTN in children and adolescents,[8, 9] and correlate more strongly with cardiovascular hypertensive TOD. [1, 9-12] Furthermore, increases in short-term and long-term BP variability have been associated with TOD, including decreased cognitive function, in hypertensive adults. [13-16] However, little is known about the relative correlation between ambulatory and office BP and cognitive test performance, and about the relation between short-term BP variability and cognitive function in children with primary HTN.…”