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Comparison of ambulatory blood pressure reference standards in children evaluated for hypertension

Deborah P Jones1, Phyllis A Richey, Bruce S Alpert

  • 1Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee 38103, USA. dpjones@utmem.edu

Blood Pressure Monitoring
|May 13, 2009
PubMed

Insights

Standardizing ambulatory blood pressure monitoring (ABPM) in children is crucial. Different reference standards can alter hypertension classification in approximately 5% of pediatric cases.

Area of Science:

  • Pediatric Cardiology
  • Clinical Hypertension Research
  • Biomedical Data Analysis

Background:

  • Accurate blood pressure measurement in children is vital for diagnosing and managing hypertension.
  • Ambulatory blood pressure monitoring (ABPM) provides valuable data for assessing blood pressure patterns over time.
  • Standardization of ABPM data is essential for consistent interpretation and clinical decision-making.

Purpose of the Study:

  • To systematically compare different standardization methods for ambulatory blood pressure monitoring (ABPM) data in a pediatric cohort.
  • To evaluate the impact of using original versus modified reference standards on blood pressure classification in children.
  • To assess the agreement between various standardization approaches for pediatric ABPM.

Main Methods:

  • Calculated blood pressure indices, loads, and standard deviation scores using both original and modified ABPM reference standards.
  • Employed Bland-Altman plots to assess the agreement in blood pressure measurements between standardization methods.
  • Utilized kappa statistics to quantify the level of agreement in hypertension classification based on different standards.

Main Results:

  • Excellent overall agreement was observed between the two standardization methods for ABPM data.
  • A notable discrepancy was found in approximately 5% of children, who were classified differently regarding their blood pressure status (hypertension vs. normal).
  • The choice of reference standards significantly influenced the classification of individual children's blood pressure levels.

Conclusions:

  • The interpretation of pediatric ABPM data can vary depending on the specific version of the German Working Group's reference standards used.
  • Clinicians must be aware of potential classification discrepancies when applying different standardization methods for ABPM in children.
  • Careful selection and consistent application of reference standards are necessary for accurate hypertension diagnosis in pediatric populations.
Abstract

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