Ambulatory blood pressure monitoring: mean blood pressure and blood pressure load

Abstract

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.

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

“…42 BP load is defined as the percentage of valid ambulatory BP measures above a set threshold value, such as the 95th percentile of BP for age, gender, and height. 89 As for mean ABPM values, this can be assessed for the entire 24-hour period or for the awake and asleep periods separately. Loads in excess of 25% to 30% are typically considered elevated.…”

Importance of Ambulatory Blood Pressure Monitoring in Adolescent Hypertension

“…German authors regard values greater than 25% [22] , while others consider values greater than 30%, as abnormal [23] . The authors of the most recent study have determined, based on investigations carried out with 728 youths under age 19, that adolescent ABPM readings are identified as abnormal if, on the one hand, they exceed the 95th percentile BP for the given subgroup, and on the other hand, BP load has reached 30% [24] . In line with this, the BP of young people is identified as normal if daytime mean is below the 95th percentile, with a BP load lower than 25% [12] .…”

Role of Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Children on Dialysis

“…BP load was defined as the percentage of readings greater than the ambulatory 95th percentile, based on gender and height (11,12), for daytime and night-time SBP and DBP or daytime SBP Ͼ130 mmHg or DBP Ͼ80 mmHg and nighttime SBP Ͼ120 mmHg or DBP Ͼ70 mmHg (13), whichever value was lower. A load Ͼ25% was considered elevated (14). Although controversy exists regarding optimal definition of hypertension by ABPM, we used the definition proposed by most experts, which requires both presence of elevated mean SBP or DBP and a SBP or DBP load Ͼ25% (11,15).…”