Related Experiment Video
Updated: Dec 12, 2025
Quantitative Autonomic Testing
Published on: July 19, 2011
Challenges of diagnosing pediatric hypertension using ambulatory blood pressure monitoring
Jason Thomas1, Emily Stonebrook2, Brett Klamer3,4
1Division of Pediatric Nephrology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA. jthomas06@gmail.com.
Insights
Ambulatory blood pressure monitoring (ABPM) diagnosis of hypertension (HTN) showed good agreement between mean arterial pressure (MAP) and systolic/diastolic BP. Adult criteria may improve pediatric HTN diagnosis accuracy.
Area of Science:
- Cardiology
- Pediatrics
- Hypertension Research
Background:
- Ambulatory blood pressure monitoring (ABPM) is used to diagnose hypertension (HTN).
- Pediatric guidelines recommend calculated systolic and diastolic blood pressure (BP) over mean arterial pressure (MAP) for HTN diagnosis.
- Current pediatric BP thresholds for HTN may differ from adult thresholds.
Purpose of the Study:
- To evaluate the agreement in diagnosing ambulatory hypertension (HTN) using mean arterial pressure (MAP) versus calculated systolic and diastolic blood pressure (BP).
- To assess agreement in HTN diagnosis using adult versus pediatric criteria in taller male children.
Main Methods:
- Retrospective analysis of 263 24-hour ABPM studies.
- Cohen's kappa coefficient used to evaluate diagnostic agreement between MAP and systolic/diastolic BP.
- Comparison of adult versus pediatric HTN criteria for males ≥165 cm.
Main Results:
- Good agreement observed between MAP and systolic/diastolic BP for HTN diagnosis (kappa = 0.75).
- Disagreement occurred in 12% of subjects.
- Good agreement between pediatric and adult criteria (kappa = 0.70), with 19 patients identified as hypertensive under alternative criteria.
Conclusions:
- Using MAP alongside systolic/diastolic BP and adult criteria for taller males may enhance pediatric HTN diagnosis accuracy.
- Potential to reduce false-negative rates in pediatric hypertension diagnosis.
- Further research is needed to validate these findings in larger cohorts.
Background:
Ambulatory blood pressure monitoring (ABPM) measures mean arterial pressure (MAP) then extrapolates systolic and diastolic blood pressure (BP) values. Pediatric guidelines recommend using calculated systolic and diastolic BP rather than measured MAP for diagnosis of ambulatory hypertension (HTN). The 95th percentile BP that defines ambulatory HTN is higher in some children than thresholds used to define ambulatory HTN in adults.
Methods:
This is a retrospective study of patients who underwent 24-h ABPM. The level of agreement in ambulatory HTN diagnosis using MAP vs. systolic/diastolic BP was evaluated using Cohen's kappa coefficient. Similar analysis was done to assess agreement in HTN diagnosis using adult vs. pediatric criteria for males taller than 165 cm.
Results:
A total of 263 ABPM studies were included. There was good agreement for diagnosis of HTN using MAP or systolic/diastolic BP (k = 0.75; 95% CI: 0.67-0.83). However, there was disagreement between the methods in 12% (n = 31) of subjects. Similarly, there was good agreement (k = 0.70; 95% CI: 0.56-0.85) between pediatric and adult criteria for HTN diagnosis. Nineteen patients were found to be hypertensive (9 using MAP criteria, 10 using adult criteria) who would not have met ambulatory HTN criteria using current pediatric guidelines.
Conclusions:
Inclusion of MAP along with systolic and diastolic BP in ABPM analysis alongside using adult criteria for diagnosing HTN in male children ≥ 165 cm may improve accuracy of pediatric HTN diagnosis and reduce false negative rate. Larger studies are needed to assess the clinical validity of these results. Graphical abstract.
More Related Videos
14:09Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
06:51Development of an Algorithm to Perform a Comprehensive Study of Autonomic Dysreflexia in Animals with High Spinal Cord Injury Using a Telemetry Device
Published on: July 29, 2016
Related Concept Videos
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:30Equipments Used To Measure Blood Pressure
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
01:25Errors occurring during blood pressure monitoring
Several factors...
01:23Assessment of blood pressure in brachial artery(two-step method)
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement