Ambulatory blood pressure monitoring in children
- Joseph T Flynn, MD, MS
Joseph T Flynn, MD, MS
- Professor of Pediatrics
- University of Washington
- Section Editors
- David R Fulton, MD
David R Fulton, MD
- Section Editor — Pediatric Cardiology
- Associate Professor of Pediatrics
- Harvard Medical School
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
Ambulatory blood pressure monitoring (ABPM) has become a helpful tool in evaluating blood pressure (BP) in children. It is increasingly used to assess patients with variable BP readings in the office, wide discrepancies between the BP readings at home and in the clinician's office (ie, "white coat" hypertension), and secondary forms of hypertension such as chronic kidney disease (CKD).
The utility and limitations of pediatric ABPM, and information on performing and interpreting ABPM studies in children will be reviewed here. The definition, diagnosis, and treatment of hypertension in children based upon office BP measurement (casual BP) are discussed separately. (See "Definition and diagnosis of hypertension in children and adolescents" and "Nonemergent treatment of hypertension in children and adolescents".)
ABPM can be successfully used in the evaluation of infants, toddlers, and older children [1-7]. However, ABPM needs to be performed in a standardized, reliable fashion to provide accurate recordings, especially in small children and infants .
Device — ABPM uses a portable automated device that records blood pressure (BP) over a specific time period (usually 24 hours). ABPM monitors most commonly used in children are small oscillometric devices, which are worn on a belt in a pouch. Oscillometric ABPM devices directly measure the mean arterial pressure and back-calculate the systolic and diastolic BP using an algorithm that is unique to each device manufacturer. Development of normative data for pediatric ABPM has been difficult because of the variation of each algorithm . Devices utilizing the auscultatory technique are also available, but are less frequently used in children because they are more cumbersome to wear [6,8]. In addition, there are no published normative pediatric ABPM data for auscultatory devices .
Procedural approach — In our center, we follow the approach that is outlined in the 2014 Scientific Statement from the American Heart Association (AHA) on ABPM in children and adolescents, which includes the following key points for obtaining accurate, reliable, and reproducible results in children :
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- Procedural approach
- Interpretation of data
- - Normative data
- - Classification of BP
- INDICATIONS FOR ABPM
- White coat hypertension
- Masked hypertension
- Sustained hypertension and nocturnal nondipping
- Risk for cardiovascular disease
- Renal damage
- Our approach
- Defining ambulatory hypertension
- Technical limitations
- INFORMATION FOR PATIENTS