Ambulatory blood pressure monitoring: a versatile tool for evaluating and managing hypertension in children

Abstract

In recent years, pediatric practitioners have increasingly used ambulatory blood pressure (ABP) monitoring for evaluating blood pressure (BP) abnormalities in children. ABP monitoring in adults is superior to casual BP measurements for predicting cardiovascular morbidity and mortality, and whereas the association with target-organ damage in children is not as definitive, early evidence does seem to parallel the adult data. In addition to confirming hypertension at diagnosis, ABP monitoring may be useful for identifying isolated nocturnal hypertension, characterizing BP patterns, and assessing response to therapeutic interventions. This article reviews current evidence supporting the use of ABP monitoring in children and discusses limitations in our understanding of this technology, specifically focusing on indications for its use and interpretation of the large quantity of data obtained by ABP monitoring.

Arterial HTN in children with T1DM-frequent and not easy to diagnose

“…In addition to previously published studies on HTN in diabetic children, we compared the OBP with the ABPM and found that 32% of patients have whitecoat HTN, and up to 10% have masked HTN. These numbers correspond to other reports on the nondiabetic children population (29)(30)(31)(32), and may seem lower than expected given the higher risk of HTN in diabetes. However, our results document that a significant number of patients may be misclassified white-coat hypertension (WCH) or HTN not diagnosed (masked HTN) if only OBP is used.…”

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

“…First, not all participants completed 24 hour ABPM and the ABPM has not yet been repeated to confirm the reproducibility of nocturnal hypertension and nocturnal dipping. While the reproducibility of nocturnal hypertension is high in pediatric populations, nocturnal blood pressure dipping has lower reproducibility [48]. Second, our data identifies a lower eGFR in patients with abnormal nocturnal hypertension and abnormal uric acid, but those eGFR values may be within the normal range.…”

Control of Hypertension in Treated Children and Its Association With Target Organ Damage

“…There are several advantages of ABPM over office BP (exclusion of the white coat effect, detection of nighttime and masked HT). 7 In our study we could detect isolated nighttime HT in 21% of all children and masked HT in 8% that would not be detected by office BP.…”

“…Ambulatory BP monitoring (ABPM) has become a valuable method in the management of HT. 7 The advantages of ABPM over clinic BP measurements are mainly the ability to reveal isolated nighttime HT, masked HT, or white coat HT. The results of ABPM in adults have demonstrated that a high number of treated hypertensive patients deemed by clinic BP to be under control do not have adequate BP control based on ABPM.…”