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

Urbina, Elaine M.; Alpert, Bruce S.; Flynn, Joseph T.; Hayman, Laura L.; Harshfield, Gregory A.; Jacobson, Mark Z.; Mahoney, Larry T.; McCrindle, Brian W.; Mietus‐Snyder, Michele; Steinberger, Julia; Daniels, Stephen R.

doi:10.1161/hypertensionaha.108.190329

Cited by 471 publications

(266 citation statements)

References 138 publications

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“…To test whether using a 90% cutoff would alter the results, all SLE patient ABPM data was re-interpreted. The data was also reanalyzed using BP loads of >30% (per institutional protocol) rather than 25% ( Urbina et al , 2008) to define HTN. In addition, to test if the quality of the ABPM data affected the findings, the comparison between cohorts was repeated after ABPM tests were discarded if either <75% of attempted BP measurements were successful, <50 total measurements were successful, or both.…”

Section: Resultsmentioning

confidence: 99%

“…BP loads were calculated for both diastolic and systolic BP, reflecting the percentage of BP measurements above the 95 th percentile for gender and age. Blood pressure loads >25% were considered abnormal ( Urbina et al , 2008). Additionally, nocturnal dipping of BP was defined as the difference between daytime and nighttime BPs.…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, nocturnal dipping of BP was defined as the difference between daytime and nighttime BPs. Nocturnal dipping <10% was considered abnormal ( Urbina et al , 2008). American Heart Association (AHA) definitions were used to define normal blood pressure, masked, white-coat and sustained HTN ( Flynn, 2011).…”

Section: Methodsmentioning

confidence: 99%

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Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

2015

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Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort, 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

2015

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“…The use of ABP monitoring in children and adolescents has gained great publicity in the last years and is regarded as an indispensable method for the diagnosis of pediatric hypertension. 16,17 Reference ABP values for children adjusted for gender and height or age are available and increased ABP values have been associated with left ventricular hypertrophy, increased carotid intima-media thickness and impaired renal function in young individuals, in most cases to a higher degree compared with CBP. 9,[11][12][13]30 On the other hand, HBP monitoring in children and adolescents is feasible 19 and reference values have been recently published.…”

Section: Discussionmentioning

confidence: 99%

“…14 Thus, the diagnosis of hypertension in children is dependent on accurate clinic and out of clinic BP measurements. 15 Reference values for ambulatory BP (ABP) in children are available 16,17 and accumulating data suggest that this method is more accurate in the diagnosis of hypertension and more closely associated with target-organ damage than the conventional clinic BP (CBP) measurements. 18 On the other hand, home BP (HBP) monitoring is regarded as an easily applicable and useful adjunct to CBP for the assessment of hypertension in adults; however data in children and adolescents are limited.…”

Section: Introductionmentioning

confidence: 99%

Relationship of home blood pressure with target-organ damage in children and adolescents

et al. 2011

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The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13±3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1 ± 15.1/71 ± 12.9 mm Hg (systolic/diastolic), HBP 121.3 ± 11.5/69.4 ± 6.6 mm Hg and 24-h ABP 118.9 ± 12/ 66.6 ± 6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r¼0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all Po0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r¼0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all Po0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r¼0.30 and 0.28, respectively, Po0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R 2 ¼0.22, beta ± s.e. ¼0.06 ± 0.01), whereas LVM was determined (R 2 ¼0.67) by 24-h pulse pressure (beta¼1.21±0.41), age (beta¼2.93±1.32), 24-h heart rate (beta¼À1.27±0.41) and BMI (beta¼1.78±0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.

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Pharmacological interventions for essential hypertension in children

Chaturvedi

Licht

Parekh

et al. 2009

Cochrane Database of Systematic Reviews

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

Cited by 471 publications

References 138 publications

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

Relationship of home blood pressure with target-organ damage in children and adolescents

Pharmacological interventions for essential hypertension in children

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