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Ambulatory blood pressure monitoring in children: a large center's experience
I A Khan1, M Gajaria, D Stephens
1Division of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, ON, Canada.
Insights
Ambulatory blood pressure monitoring (ABPM) is feasible in children, with a 17% failure rate in studies. Most children tolerated ABPM, revealing elevated blood pressure loads and informing treatment adjustments.
Area of Science:
- Pediatrics
- Cardiology
- Clinical Research
Background:
- Ambulatory blood pressure monitoring (ABPM) is established in adults and increasingly used in pediatric populations.
- Previous studies have not comprehensively assessed ABPM's utility and challenges in children.
Purpose of the Study:
- To evaluate the failure rate of ABPM studies in children.
- To analyze the clinical experience and utility of ABPM in pediatric patients aged 5-19 years.
- To identify patterns in blood pressure, heart rate, and nocturnal dipping in children.
Main Methods:
- Retrospective review of 190 ABPM studies conducted since 1990.
- Analysis of data from 97 pediatric patients (5-19 years old) between 1992 and 1996.
- Assessment of study failure rates, patient tolerance, blood pressure readings (day/night), and nocturnal BP fall.
Main Results:
- Seventeen percent (32/190) of ABPM studies failed.
- Most children accepted ABPM after clear explanation; 89% (86/97) had elevated blood pressure load.
- Clinic systolic BP was higher than daytime ABPM, suggesting a "white coat" effect; antihypertensive medications were adjusted in 16% of patients.
Conclusions:
- ABPM is a useful technique in selected pediatric cases, including borderline/secondary hypertension and difficult therapeutic monitoring.
- Further research is needed for normative ABPM data in North American children.
- Nocturnal blood pressure dipping patterns were observed, with attenuation in children with kidney disease or organ transplants.
Abstract:
Ambulatory blood pressure monitoring (ABPM) is well established in adults and is becoming common in children. We reviewed 190 ABPM studies retrospectively (since 1990) to assess the failure rate, and analyzed the data from 97 patients 5-19 years old (1992-1996) to review the experience gained from the use of this technique in children and adolescents. Seventeen percent (32/190) of studies failed. Most children accepted ABPM, provided it was clearly explained in advance. There were differences between day and night readings of systolic blood pressure (BP), diastolic BP, and heart rate. BP did not correlate with height or weight. "White coat" effect apparently exists in children: clinic systolic BPs were higher than daytime systolic ABPM (no difference in diastolic). Eighty-nine percent (86/97) had an elevated BP load (>30% of readings >95th percentile). The antihypertensive medications of 16% (16/97) of patients were changed after ABPM. The nocturnal fall in BP (expressed as a percentage of the individual mean daytime values) was approximately normally distributed and was independent of age and height. Nocturnal systolic and diastolic dipping were closely correlated. Attenuation of nighttime dipping was observed in children with kidney disease and those with organ transplants. There is a need for normative data for ABPM for North American children. In our study, the technique was useful in selected cases, such as borderline or secondary hypertension, and for therapeutic monitoring when BP control is difficult.