Pediatric Ambulatory Blood Pressure Classification: The Case for a Change

Abstract

In 1997, Soergel et al 1 published the first set of normative values for ambulatory blood pressure monitoring (ABPM) in children. Since then, the clinical utility of ABPM has increased dramatically, and now, ABPM is accepted as the standard method to confirm the diagnosis of hypertension in children. Despite significant progress in the field of pediatric ABPM, many important questions remain unanswered. One of the most controversial issues is how to define ambulatory hypertension in children. The purpose of this review is to discuss the limitations of the current pediatric ABPM classification scheme and to provide the justification and rationale for a new classification.

High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

“… 169 However, up to 20% to 40% of children are unclassified using these criteria and hypertension thresholds may be higher than adult thresholds for children ≥12 years old. 184 , 185 , 186 There is emerging evidence that isolated elevated BP load is not significantly associated with target organ damage. 185 , 187 , 188 Removing BP load criteria and using adult thresholds for adolescents would simplify ABPM interpretation.…”

“… 185 , 187 , 188 Removing BP load criteria and using adult thresholds for adolescents would simplify ABPM interpretation. 186 , 188 Because oscillometric ABPM devices measure MAP, it may also be preferable to classify ABPM using MAP, instead of calculated systolic/diastolic BP.…”

Joint statement for assessing and managing high blood pressure in children and adolescents: Chapter 1. How to correctly measure blood pressure in children and adolescents

“…Differences in guidelines among various societies, as well as gaps in knowledge lead to ambiguity regarding 24-h ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasons for variation in physicianś interpretations could help standardise practice ( 10 – 12 , 36 ). In the following materials we present indications for 24-h ambulatory blood pressure monitoring ( Table 5 ), advantages and limitations of 24-h ambulatory blood pressure monitoring vs. office blood pressure ( Table 6 ), methodology for 24-h ambulatory blood pressure monitoring ( Box 2 ), interpretation of 24-h ambulatory blood pressure monitoring ( Table 7 ), blood pressure phenotypes according to office and ambulatory blood pressure monitoring ( Table 8 ).…”

“…Differences in guidelines among various societies, as well as gaps in knowledge lead to ambiguity regarding 24-h ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasons for variation in physicianś interpretations could help standardise practice ( 10 – 12 , 36 ).…”

Is It Time to Drop Unclassified Category in Pediatric Ambulatory Blood Pressure Monitoring?

“…The Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth (SHIP AHOY) 3 study did not find any additional benefit of including BP load to define hypertension with pediatric ABPM but did not specifically address unclassified patients. A recent review highlighted these concerns, 4 suggesting BP load be eliminated from the pediatric ABPM definition of hypertension and recommending the use of the 2017 American College of Cardiology/American Heart Association adult thresholds for children ≥13 years of age. This study aimed to evaluate the significance of elevated ambulatory BP load in unclassified patients by contrasting the pediatric versus adult criteria for this group and assessing the association with left ventricular hypertrophy (LVH).…”