Utility of ambulatory blood pressure monitoring in children and adolescents

Abstract

Diagnosis of hypertension is critically dependent on accurate blood pressure measurement. "Accurate" refers to carefully following the guidelines for blood pressure measurement laid out for children and adults to minimize observer and subject errors that commonly occur in clinical blood pressure measurement. Accurate blood pressure measurement is more important in children and adolescents as the misdiagnosis of hypertension may have a life-long adverse impact on insurability and employment. Automated blood pressure measurement offers multiple advantages in achieving high-quality blood pressure determinations by reducing observer errors. The most commonly used form of automated blood pressure measurement is 24-h ambulatory blood pressure measurement (ABPM). Information on ABPM in children has grown exponentially over the last decade. Normative data exists for diagnosis of hypertension in children using ABPM including a novel method for determining normal values with the LMS method. There is further information about the utility of different determinants of 24-h blood pressure such as dipping status, morning surge and blood pressure load. ABPM has been able to detect significant differences in blood pressure in many disease states in children including chronic renal failure, polycystic kidney disease, solitary functioning kidney, and after renal transplantation. Increasingly nonambulatory automated blood pressure determinations have been used in management of hypertension in children. Although nonambulatory automated readings lack information about nocturnal blood pressure or blood pressure during daily activity, studies have suggested that home automated blood pressure measurements are a helpful adjunct to the usual office blood pressure reading.

The diabetic pregnancy and offspring blood pressure in childhood: a systematic review and meta-analysis

“…Methods used for BP measurement varied among studies in our meta-analysis; they included manual sphygmomanometers, as well as automated devices, which have the advantage of achieving high-quality BP determinations by reducing observer errors [64]. In three studies, the method used for BP measurement was not stated.…”

Dimercaptosuccinic acid (DMSA) renal scan in the evaluation of hypertension in children

“…Renal scarring is a well-known cause for hypertension and proteinuria, with progression to end-stage renal disease (ESRD) in some pediatric patients [12,13]. The 24-h ambulatory blood pressure monitoring (ABPM) is being increasingly used in children with renal disease, including those with scarring [14]. In a study published by Milosevski et al, ABPM demonstrated nocturnal systolic hypertension in all patients with renal scarring [15].…”

Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment

“…12,13 This statement summarizes the current research and clinical applications of ABPM in children and adolescents and offers recommendations on implementation of ABPM in practice and interpretation of results. Because no outcome studies are yet available relating ABPM levels in children to hard outcomes such as myocardial infarction or stroke, these guidelines are expert opinion-driven and not evidence based.…”

“…12 In these patients, ABPM can be very helpful in stratifying risk for target organ damage, because even with normal average ABPM values, increased BP variability is associated with target organ damage in adults. 52 This may be especially relevant if there is a strong family history of hypertension, because BP variance is under substantial genetic control.…”