Pediatric ambulatory blood pressure monitoring: indications and interpretations

Abstract

The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.

Figure 1

Utility of ambulatory blood pressure monitoring in the diagnosis of secondary hypertension (HTN). Presence of daytime diastolic blood pressure (DBP) load >25% and nocturnal systolic blood pressure (SBP) load >50% had 92% specificity for predicting secondary HTN. ²⁶

Figure 2

Arterial stiffness by blood pressure (BP) measurement technique. PWV indicates pulse wave velocity; ABPM, ambulatory blood pressure monitoring; NS, not signficicant. ⁹¹

Figure 3

Glomerular filtration rate (GFR) at baseline and change in GFR by blood pressure classification in the Chronic Kidney Disease in Children (CKiD) Study.¹⁰⁴ CKD indicates chronic kidney disease; WT, weight; HT, height.

Figure 4

Calculation of ambulatory arterial stiffness index (AASI) (Urbina, unpublished data, 2012). SBP indicates systolic blood pressure; DBP, diastolic blood pressure.

Figure 5

Graph of mean daytime diastolic ambulatory blood pressure for girls according to height. ¹²³ Reprinted with permission from Soergel et al.¹²³