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Ambulatory blood pressure monitoring in children

Joseph T Flynn, MD, MS
Section Editors
David R Fulton, MD
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


Ambulatory blood pressure monitoring (ABPM) has become an invaluable 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 has been successfully used in the evaluation of BP infants, toddlers, and older children in research settings [1-8]. However, it is most feasible for clinical use in children old enough to cooperate with the procedure. ABPM needs to be performed in a standardized, reliable fashion to provide accurate recordings, especially in small children and infants [6].

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. Pulse wave amplitude and the elastic properties of the arterial wall, which are important factors in algorithm development, are different in children and adults. Thus, both the monitors and algorithms used in ABPM need to be validated using a standard protocol in children [9]. (See 'Technical limitations' below.)

Development of normative data for pediatric ABPM has been difficult because of the variation of each algorithm [5]. Devices utilizing the auscultatory technique are also available, but are less frequently used in children because they are more cumbersome to wear [6,10]. In addition, there are no published normative pediatric ABPM data for auscultatory devices [6].

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Literature review current through: Nov 2017. | This topic last updated: Oct 13, 2017.
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