Ambulatory blood pressure monitoring (ABPM) is well established in adults and is becoming common in children. We reviewed 190 ABPM studies retrospectively (since 1990) to assess the failure rate, and analyzed the data from 97 patients 5-19 years old (1992-1996) to review the experience gained from the use of this technique in children and adolescents. Seventeen percent (32/190) of studies failed. Most children accepted ABPM, provided it was clearly explained in advance. There were differences between day and night readings of systolic blood pressure (BP), diastolic BP, and heart rate. BP did not correlate with height or weight. "White coat" effect apparently exists in children: clinic systolic BPs were higher than daytime systolic ABPM (no difference in diastolic). Eighty-nine percent (86/97) had an elevated BP load (>30% of readings >95th percentile). The antihypertensive medications of 16% (16/97) of patients were changed after ABPM. The nocturnal fall in BP (expressed as a percentage of the individual mean daytime values) was approximately normally distributed and was independent of age and height. Nocturnal systolic and diastolic dipping were closely correlated. Attenuation of nighttime dipping was observed in children with kidney disease and those with organ transplants. There is a need for normative data for ABPM for North American children. In our study, the technique was useful in selected cases, such as borderline or secondary hypertension, and for therapeutic monitoring when BP control is difficult.
Ambulatory blood pressure monitoring (ABPM) is commonly used to diagnose pediatric hypertension. Using ABPM, hypertension is usually defined as a mean BP greater than the 95th percentile for height. A BP load >30% (% of BP readings greater than the 95th percentile) is also used for the diagnosis of hypertension. The objective of this study was to determine the agreement between mean BP greater than the 95th percentile and 30% BP load for the diagnosis of hypertension using ABPM. All ABPM records (n =1,009) of patients referred for hypertension to a pediatric center were retrieved. Scans were excluded if: age was >19 and height <115 cm or >185 cm. Mean BP and BP loads were calculated for 728 scans. Agreement between mean BP greater than the 95th percentile for height and various BP loads were calculated using the kappa coefficient. The kappa coefficient of agreement between mean BP greater than the 95th percentile and 30% BP load was 0.56 and 0.57 for daytime systolic and diastolic BP, respectively. The agreement between mean night-time BP greater than the 95th percentile and 30% BP load was 0.70 and 0.66 for systolic and diastolic BP, respectively. Agreement between mean BP greater than the 95th percentile and 30% BP load is only moderate to good. Maximum agreement between mean BP greater than the 95th percentile and BP load is achieved at 50% BP load.
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