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Ambulatory blood pressure status in children: comparing alternate limit sources
Cynthia S Bell1, Tim S Poffenbarger, Joshua A Samuels
1Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center at Houston, 6431 Fannin (MSB 3.121), Houston, TX 77030, USA. cynthia.bell@uth.tmc.edu
Insights
The Wühl ambulatory blood pressure (ABP) limits identify more children as hypertensive than the Soergel limits. However, both methods largely agree on hypertension classification in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Clinical Diagnostics
Background:
- The American Heart Association adopted updated ambulatory blood pressure (ABP) limits for children from Wühl (2002).
- These new limits use the same pediatric data as the prior Soergel (1997) limits but employ different analytical methods.
- The impact of these differing ABP limit sources on pediatric hypertension diagnosis requires investigation.
Purpose of the Study:
- To evaluate the implications of using Wühl versus Soergel ambulatory blood pressure (ABP) limits on the diagnosis of hypertension in a large pediatric cohort.
- To compare the classification of hypertension, prehypertension, and white-coat hypertension between the two sets of ABP limits.
Main Methods:
- A retrospective review of 741 ambulatory blood pressure (ABP) monitorings in children referred to a hypertension clinic (1991-2007).
- Hypertension was defined using 24-hour mean blood pressure ≥ 95th percentile or blood pressure load ≥ 25% according to both Soergel and Wühl limits.
- Classification agreement and differences between the two limit sources were analyzed.
Main Results:
- Six hundred seventy-three (91%) children received the same classification by both Wühl and Soergel limits.
- Wühl limits resulted in a higher classification of hypertension (443 vs. 409 children).
- Wühl limits increased prehypertension and decreased white-coat hypertension classifications, while ambulatory and severe hypertension counts were similar.
Conclusions:
- While Wühl limits identify more children as hypertensive, the choice of limit source does not significantly alter most clinical outcomes for pediatric hypertension.
- Consistency in using either Soergel or Wühl limits is recommended for long-term pediatric research.
- There is a need for new normative ambulatory blood pressure (ABP) data from larger, multiethnic pediatric populations.
Abstract:
The American Heart Association has included alternate ambulatory blood pressure (ABP) limits for children published by Wühl in 2002. These updated limits employ the same pediatric cohort data as the previous ABP limits published by Soergel in 1997 but differ in analysis technique. The implications of changing ABP limit source on the diagnosis of hypertension has yet to be examined in a large pediatric cohort. We reviewed 741 ABP monitorings performed in children referred to our hypertension clinic between 1991-2007. Hypertension was defined as 24-h mean blood pressure ≥ 95 th percentile or 24-h blood pressure load ≥ 25%, by Soergel and Wühl limits separately. Six hundred seventy-three (91%) children were classified the same by both limit sources. Wühl limits were more likely than Soergel to classify a child as hypertensive (443 vs. 409, respectively). There was an increased classification of prehypertension and decreased white-coat hypertension by the Wühl method, whereas ambulatory and severe hypertension counts remained relatively the same by both limits sources. The use of either limit source will not significantly affect most clinical outcomes but should remain consistent over long-term research projects. Collection of new normative data from a larger, multiethnic population is needed for better measurement of ABP in children.
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