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Ambulatory Blood Pressure Thresholds and Left Ventricular Hypertrophy in Children Aged 6-12 Years: A Pediatric

Afsana Jahan1, Matthew Schuchman1, Mahie Abdullah1

  • 1Division of Pediatric Nephrology, Northwell Health, Cohen Children's Medical Center, New Hyde Park, NY.

The Journal of Pediatrics
|June 15, 2026
PubMed

Insights

Ambulatory blood pressure monitoring (ABPM) thresholds show limited ability to predict left ventricular hypertrophy (LVH) in children. Nighttime blood pressure measurements were most strongly associated with LVH, highlighting their importance.

Area of Science:

  • Pediatric Cardiology
  • Hypertension Research
  • Diagnostic Accuracy Studies

Background:

  • Left ventricular hypertrophy (LVH) is a significant indicator of cardiovascular risk in children.
  • Accurate prediction of LVH is crucial for timely intervention and management.
  • Ambulatory blood pressure monitoring (ABPM) is increasingly used to assess blood pressure (BP) patterns in pediatric populations.

Purpose of the Study:

  • To evaluate the diagnostic performance of various ambulatory blood pressure monitoring (ABPM) thresholds for predicting left ventricular hypertrophy (LVH) in children aged 6-12 years.
  • To compare the predictive accuracy of fixed ABPM thresholds and current percentile-based guidelines for LVH detection.
  • To identify specific ABPM parameters most strongly associated with LVH in this pediatric cohort.

Main Methods:

  • A retrospective, multicenter study involving 279 children aged 6-12 years who underwent both ABPM and 2D echocardiography.
  • Assessment of diagnostic accuracy using area under the receiver operating characteristic (AUROC) curves, sensitivity, specificity, and Youden index for different ABPM thresholds.
  • Multivariable logistic regression analysis, adjusted for age, sex, and BMI z-score, to determine the association between ABPM thresholds and LVH.

Main Results:

  • Hypertension was present in 51% and LVH in approximately 20% of the study cohort.
  • Fixed and percentile-based ABPM thresholds demonstrated poor discriminatory performance for LVH (AUROC 0.5-0.6).
  • Nighttime systolic BP ≥110 mmHg and nighttime diastolic BP ≥70 mmHg were significantly associated with increased odds of LVH (ORs ~2.0, p=0.03).

Conclusions:

  • Standard ABPM thresholds have limited utility in predicting LVH in children aged 6-12 years.
  • Nocturnal blood pressure, both systolic and diastolic, emerged as a stronger predictor of LVH compared to daytime or 24-hour measurements.
  • Emphasis on nocturnal BP assessment is warranted for improved LVH risk stratification in pediatric hypertension.
Abstract

Keywords:
ambulatory blood pressure monitoringblood pressure thresholdschildhood hypertensionleft ventricular hypertrophy

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