24 hour blood pressure monitoring in healthy and hypertensive children.

Abstract

24 Hour ambulatory blood pressure monitoring (ABPM) was performed to provide data on the normal daily blood pressure of healthy schoolchildren and on patients with hypertension. The subjects studied were 123 healthy schoolchildren with a mean (SD) age of 12-5 (1-6) years (range 9-5-14-5 years), 24 children with borderline or mild hypertension, 17 with renal hypertension and normal renal function, 10 with chronic renal failure, and six with a renal allograft. In eight children with definite renal disease a second measurement was performed after treatment modification.The monitor used for ABPM was validated with a mercury column manometer. The mean (SD) of the signed differences ofthe blood pressure measured by the two methods was -0-19 (1-75) mm Hg for the systolic and -0-21 (2.11) mm Hg for the diastolic blood pressure (n=60). Normal values for daytime and night time blood pressure were determined for those aged 10-14 years. The mean (SD) blood pressure of the 123 children was 109 (7)/66 (8) mm Hg (systolic/diastolic) for the daytime and 96 (8)/52 (7) mm Hg at night time. Ofthe 24 children with borderline or mild hypertension 14 had a raised blood pressure on ABPM. The circadian rhythm was disturbed in three children of this group. Even children with normal daytime blood pressure had significantly higher systolic blood pressure in the night when compared with the controls. The incidence of disturbed circadian rhythm was higher in the groups with renal hypertension (4/17 in the subgroup with normal renal function, 5/16 in the group with renal failure and/or transplantation). All children undergoing a second ABPM measurement had a lower average blood pressure after treatment adjustment.ABPM measurements were reproducible and accurate. The method provided new data on the physiological circadian variation of blood pressure in healthy children. It proved to be a helpfil tool in the diagnosis of hypertension, particularly in the detection of cases of disturbance of the circadian rhythm of blood pressure pattern and individual adjustment oftreatment. (Arch Dis Child 1994; 70: 90-94)

Diurnal blood pressure patterns in normotensive and hypertensive children and adolescents

“…6,[25][26][27][28][29] In general, our findings are congruent with the reported higher nocturnal BP levels, 6,[25][26][27]29 BP loads 25,28,29 and similar diurnal BP patterns 26 in hypertensive compared with normotensive children. One previous study found cosine curves gen- had a higher average BP or midline estimating statistic of rhythm-adjusted mean (MESOR) than the sive than normotensive children when expressed as normotensive group with each group showing a the nocturnal BP fall or CDCAM, but both groups minimum BP at about 3 am and maximum BP at had a similar night-day SBP ratio.…”

“…The difference between daytime and nighttime systolic BP (SBP) in healthy normotensive adoAll subjects undergoing 24-h ambulatory BP monilescents is approximately 8-13%, with higher toring between March, 1992 and July, 1996 at Arkmeasurements obtained during waking hours. [2][3][4][5][6][7][8] ansas Children's Hospital were included in this Little information is available, however, on the diuranalysis if they fulfilled the following criteria: nal SBP pattern of children and adolescents with…”

Influence of the postoperative period and surgical procedure on ambulatory blood pressure-determination of hypertension load after successful surgical repair of coarctation of the aorta

“…Results in the adult population generally indicate that between 20% and 30% of patients diagnosed as hypertensive on the basis of office blood pressure measurements are found to have normal blood pressure when measured at home or when evaluated by 24-h ambulatory blood pressure monitoring [1][2] . In the last 5 to 10 years, numerous reports have been published on ambulatory blood pressure monitoring of healthy and hypertensive North American and European children and adolescents [3][4][5][6][7] . Results generally indicate that while ambulatory blood pressure is well tolerated and provides reproducible and accurate measurements [5,8] , up to 85% of adolescents diagnosed with diastolic hypertension and up to 70% diagnosed with systolic hypertension on the basis of office blood pressure determination may be found to have daytime ambulatory blood pressure readings below 90 mmHg and 140 mmHg, respectively [9] .…”

Importance of Ambulatory Blood Pressure Monitoring in Adolescent Hypertension

“…This was followed by a publication by Reusz et al [10] in 1994, in which, in addition to the ABPM readings of 125 healthy schoolchildren, those of young hypertensives and patients known to have kidney disease were also reported on. It was stressed even then that ABPM cannot only be used for diagnostic purposes but that changes in the diurnal rhythm might also suggest changed vasoreactivity.…”

“…They show that some data are already known in terms of normal values [10] ; however, the guidelines do not find them sufficient to establish reliable reference values. The guidelines also mention that ABPM is becoming increasingly popular in treating adult ABPM, but its wider use in adolescents can only become possible if we have more data at our disposal.…”