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Automated blood pressure measurement in children
1Zentrum für Kinderheilkunde, Abteilung Allgemeine Pädiatrie und Neonatologie, Justus-Liebig Universität Giessen, Germany.
Insights
Pediatric ambulatory blood pressure measurement (ABPM) requires specific reference values, differing from casual measurements. New studies provide these essential pediatric ABPM norms for accurate diagnosis and monitoring of hypertension in children.
Area of Science:
- Pediatrics
- Cardiology
- Clinical Measurement
Background:
- Blood pressure measurement in children, especially infants, requires specialized cuffs and reference values.
- Oscillometric devices are the standard automated method for pediatric blood pressure monitoring.
- Ambulatory blood pressure measurement (ABPM) is increasingly vital for diagnosing and managing hypertension in pediatric populations.
Purpose of the Study:
- To establish pediatric reference values for ambulatory blood pressure measurement (ABPM).
- To highlight the differences between casual and ABPM reference values in children.
- To emphasize the need for appropriate ABPM references in pediatric hypertension management.
Main Methods:
- Utilized data from single-center and a multicenter study involving 1141 participants.
- Analyzed daytime mean systolic and diastolic blood pressure in relation to height and sex.
- Determined the 95th percentile for upper normal ABPM values.
Main Results:
- Daytime mean systolic blood pressure increased with height in both girls and boys.
- Daytime mean diastolic blood pressure remained consistent across maturation, irrespective of height and sex.
- Upper normal ABPM values were 13-15 mm Hg above the mean.
Conclusions:
- Established new pediatric reference values for ABPM.
- Demonstrated that casual blood pressure references are inadequate for ABPM interpretation in children.
- Stressed the critical importance of using specific pediatric ABPM reference values for accurate clinical assessment.
Abstract:
Techniques to measure blood pressure are even more complicated in children and particularly in infants as in adults, since appropriate cuff sizes and special reference values are necessary. In pediatric patients oscillometry is the automated method of choice and is in use since more than 15 years (Dinamap). Recently, ambulatory blood pressure measurement (ABPM) with an oscillometric device (SpaceLabs) has become a valuable too in the diagnosis and therapeutic monitoring of arterial hypertension of children and adolescents. Normal casual blood pressure measurements have been studied in large studies demonstrating an increase of systolic and diastolic blood pressure with age, or even more with body height. These reference values are not applicable to evaluate ABPM. Recent studies in single centers as well as a multicenter study (of 1141 participants) have provided pediatric reference values for ABPM. Daytime mean systolic blood pressure increased with height from 111 to 120 mm Hg in girls (body height 120 to 180 cm) as well as in boys from 112 to 124 mm Hg. However, daytime mean diastolic blood pressure did not change during maturation and was 72 to 74 mm Hg irrespective of height and sex. The upper normal values (95th percentile) were 13-15 mm Hg above the mean. Since there is a striking difference between normal casual blood pressure and normal ABPM in children, it is essential to use appropriate blood pressure references.
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