24 hour blood pressure monitoring in healthy and hypertensive children

24 Hour ambulatory blood pressure monitoring (ABPM) was performed to provide data on the normal daily blood pressure of healthy schoolchildren and on patients with hypertension. The subjects studied were 123 healthy schoolchildren with a mean (SD) age of 12.5 (1.6) years (range 9.5-14.5 years), 24 children with borderline or mild hypertension, 17 with renal hypertension and normal renal function, 10 with chronic renal failure, and six with a renal allograft. In eight children with definite renal disease a second measurement was performed after treatment modification. The monitor used for ABPM was validated with a mercury column manometer. The mean (SD) of the signed differences of the blood pressure measured by the two methods was -0.19 (1.75) mmHg for the systolic and -0.21 (2.11) mmHg for the diastolic blood pressure (n = 60). Normal values for daytime and night time blood pressure were determined for those aged 10-14 years. The mean (SD) blood pressure of the 123 children was 109 (7)/66 (8) mmHg (systolic/diastolic) for the daytime and 96 (8)/52 (7) mmHg at night time. Of the 24 children with borderline or mild hypertension 14 had a raised blood pressure on ABPM. The circadian rhythm was disturbed in three children of this group. Even children with normal daytime blood pressure had significantly higher systolic blood pressure in the night when compared with the controls. The incidence of disturbed circadian rhythm was higher in the groups with renal hypertension (4/17 in the subgroup with normal renal function, 5/16 in the group with renal failure and/or transplantation). All children undergoing a second ABPM measurement had a lower average blood pressure after treatment adjustment. ABPM measurements were reproducible and accurate. The method provided new data on the physiological circadian variation of blood pressure in healthy children. It proved to be a helpful tool in the diagnosis of hypertension, particularly in the detection of cases of disturbance of the circadian rhythm of blood pressure pattern and individual adjustment of treatment.     

Twenty-four hour blood pressure monitoring in healthy children

Blood pressure and heart rate were measured every 20 min during the day and every 30 min during the night in 105 children (51 girls and 54 boys, aged 6–10 years) with a portable automated blood pressure monitor using an oscillometric principle of measurement. The monitor was well accepted by most of the children and the rate of invalid measurements was only 13%. Mean systolic and diastolic blood pressure was 114±7/72±5 by day and 99±7/56±6 by night. The corresponding heart rates were 93±8 and 72±9 beats/min. No significant differences were found between boys and girls. At night, systolic blood pressure dropped by 13%±4%, the diastolic value by 22%±7% and heart rate fell by 22%±6%. Mean systolic and diastolic blood pressure measurements correlated positively with the subject's height, whereas no correlation was found with age.     

Efficacy of 24-hour ambulatory blood pressure monitoring in children

OBJECTIVES: To determine whether the use of an ambulatory blood pressure monitor (ABPM) is feasible and gives accurate readings in children, and to provide data on normal daily blood pressures (BPs) and BP patterns in children. DESIGN: Cohort. SUBJECTS: Ninety-nine healthy fifth-grade students. INTERVENTIONS: Students wore an ABPM for 24 hours while recording their activities in diaries. Before and after the study period, each subject had three BPs simultaneously measured with the ABPM and a mercury manometer to assess the accuracy of the ABPM. An activity scale was retrospectively applied to diary entries to help explain the variety of BP patterns noted during data analysis. RESULTS: Systolic BPs obtained with the ABPM at the beginning and end of the study were slightly higher than those obtained with a mercury manometer; diastolic BPs were virtually identical. A circadian pattern of BPs was noted: mean systolic and diastolic BPs were higher during the day than at night. The BP patterns ranged from "hypoactive" (little baseline variation) to "hyperactive" (wide fluctuations with spikes to elevated BP ranges) during various activities. In general, higher BPs were noted at times of increased activity or emotional levels. CONCLUSIONS: Ambulatory BP monitoring was well tolerated, and measurements were reproducible and accurate. The variety of BP measurements noted at different activity levels indicate that a child's activity should be considered during data analysis. As further experience is gained, the ABPM should prove helpful in diagnosis and management of hypertension in children.     

Twenty four hour intermittent,ambulatory blood pressure monitoring.

Blood pressure and heart rate were measured every 30 minutes during the day and every hour during the night in 43 children (20 girls and 23 boys, aged 10 to 16) with a portable automated monitor. The apparatus was better accepted in girls than in boys, and the failure rate was lower during the day. The overall failure rate was 22%, which corresponds with comparable studies in adults. During the night blood pressure and heart rate fell by 10% and 14% of the daytime values, respectively. Mean (SD) blood pressure was significantly higher in boys than in girls (126/72 (17/8) v 109/64 (9/5) mm Hg) and measurements correlated positively with age, body weight, and height of the subjects. Heart rate was not significantly influenced by gender or age. A positive correlation between heart rate and blood pressure was found when expressed as standard normal deviations or hourly variations. In children intermittent monitoring of ambulatory blood pressure and heart rate is a suitable method for measuring individual diurnal patterns.     

Ambulatory blood pressure monitoring in children

Recently there have been great advances in the use of ambulatory blood pressure monitoring (ABPM) in children. A major boost has been the publication of normative data for blood pressure in children. ABPM has been able to detect significant differences in blood pressure in many disease states including chronic renal failure, polycystic kidney disease and post renal transplantation and has helped in identifying both white coat hypertension and masked hypertension. Current evidence does suggest that sole reliance on clinic blood pressure might not be always appropriate and ABPM has a definite role in pediatric hypertension.     

Ambulatory blood pressure monitoring in children and adolescents

With recent technological advances, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) has become a useful tool for the evaluation, diagnosis, and management of hypertensive children. It provides a more accurate representation of an individual's BP rather than intermittent casual or office BP measurements. Hence, ABPM is being used more often to assess the BP of children. In this comprehensive review, we provide the reader with the available literature on ABPM, discuss the advantages and limitations of ABPM, and the interpretation of ABPM data. The role of ABPM in various clinical conditions and hypertension research in children is presented.     

24小时血压监测评价儿童神经介导性晕厥治疗效果

目的：探讨24 h血压监测（ABPM）评价儿童神经介导性晕厥（NMS）治疗效果。方法：选择2010年 2月至2012年8月以不明原因晕厥或先兆晕厥为主诉,经直立倾斜试验（HUTT）诊断明确的NMS患儿28例,其中男12例,女16例,年龄6～13岁。经健康教育结合口服补液盐（ORS）治疗后复查临床症状、HUTT及ABPM。结果：（1）28例NMS患儿中,血管抑制型22例,混合型5例,心脏抑制型1例。（2）治疗效果随访：临床症状好转率96%（27/28）,HUTT好转率64%（18/28）。（3）ABPM随访：全天平均收缩压、全天平均舒张压、日间平均收缩压、日间平均舒张压、夜间平均收缩压、夜间平均舒张压、收缩压昼夜差值、舒张压昼夜差值在治疗前后差异均无统计学意义（P>0.05）。（4）ABPM参数昼夜变化模式：“勺型血压”从治疗前的29%（8/28）提高到治疗后的50%（14/28）;“非勺型血压”从治疗前的71%（20/28）下降到治疗后的50%（14/28）。结论：ABPM作为一种有效、客观、无创性监测方法,对评价儿童NMS治疗效果具有一定的临床意义。     

Microstructure of longitudinal 24 hour electroencephalograms in healthy preterm infants

BACKGROUND: The aims of the present study were to find electroencephalographic parameters that appropriately represent the microstructure of electroencephalograms (EEG) in different sleep states and to find quantitative criteria for an automatic system of sleep-state classification in preterm infants. METHODS AND RESULTS: Continuous 24 h EEG was performed in 14 normal preterm infants for whom 26 EEG records were obtained. Based on respiratory activity, body movements and rapid eye movements, the different sleep states were determined visually in 30 s epochs. Seven EEG parameters, Minimum Akaike Information Criterion (Min-AIC), total power (TP), component powers (delta, theta, alpha and beta), and the discontinuity were calculated by means of autoregressive and component analyses in 30 s epochs. The student's t test was performed independently for each parameter. Four of the seven parameters (Min-AIC, TP, delta component power and the discontinuity) showed significant differences in different sleep states. The results of multivariate discriminant analysis revealed that the combination of Min-AIC, TP, delta component power and the discontinuity of EEG defined the EEG sleep states well. CONCLUSION: The combination of Min-AIC. TP, delta component power and the discontinuity of EEG defined the EEG sleep states well and might be used to predict sleep state changes in preterm infants of conceptional ages of more than 30 weeks.     

Continuous non-invasive finger blood pressure monitoring in children

Tanaka H, Thulesius O, Yamaguchi H, Mino M, Konishi K. Continuous non-invasive finger blood pressure monitoring in children. Acta Padiatr 1994;83:646–52. Stockholm. ISSN 0803–5253
We evaluated the performance of continuous non-invasive finger arterial pressure measurement using the volume-clamp technique (Finapres). The study was designed to compare finger arterial pressure with brachial blood pressure estimated by the auscultatory method in 217 children (90 boys and 127 girls) aged 4–16 years and in 38 adults (aged 18–45 years). Finger and brachial artery pressure readings were obtained consecutively from the ipsilateral side in the supine position. Fingcr arterial pressure waveforms were recorded in all children except 4 with small and thin fingers. There was good agreement for systolic pressure with only a slight underestimation of 1.9 mmHg and 5.1 mmHg lower for diastolic pressure. This difference most probably reflects inaccuracy of the auscultatory cuff method rather than an error in the Finapres. There was large inter-individual variability in Finapres recordings which might be due to diffcrences in vasomotor tone, as demonstrated by systolic amplification in 5 patients with anorexia. However, Finapres showed a small within-subject variability (3.8 mmHg for systolic and 4.1 mmHg for diastolic pressure) dctermined in 5 patients during phenylephrine infusion, and as good reproducibility as the auscultatory method. These results suggest that finger arterial pressure measurement in children older than 6 years of age has similar accuracy as that in adults, and that this method is useful for clinical applications in children, especially for the non-invasive evaluation of autonomic control and cardiovascular reflexes involving transient and rapid blood pressure changes.     

Cardiac arrhythmias in healthy children revealed by 24-hour ambulatory ECG monitoring

Summary Ambulatory electrocardiographic monitoring was performed on 360 healthy children, from newborn infants to junior high school students. They were divided into five groups by age: group A, 63 newborn infants on the first day of life; group B, 50 infants aged 1–11 months; group C, 53 kindergarten pupils aged 4–6 years; group D, 97 primary school pupils aged 9–12 years; and group E, 97 junior high school students aged 13–15 years.The maximal and minimal heart rates were significantly greater in infants than in older children. Sinus arrhythmia was recorded in every child. One boy in group E had an episode of sinus arrest for three seconds without any symptoms. First-degree and Wenckebach type second-degree atrioventricular blocks were not detected in group A and group B, but were most frequent in group E, especially during sleep. Supraventricular premature contractions (SVPCs) were the most common type of arrhythmia detected in this study. More than half of the children had at least one SVPC per 24-h monitoring period, and there were many children with frequent SVPCs in group E. The incidence of ventricular premature contractions (VPCs) in children of groups A and E was rather higher than in the other groups. Ventricular tachycardia was not recorded in any child except one newborn infant who had a couplet of VPCs without symptoms.Each group had different types and incidences of arrhythmias. There was a rising incidence of arrhythmias with advancing age, except in the neonatal period.     

24小时动态血压监测直立性高血压患儿血压类型的病例对照研究

目的采用24 h动态血压(ABPM)方法探讨直立性高血压(OHT)患儿的血压类型。方法选取2009年10月至2013年9月在中南大学湘雅二医院(我院)儿童晕厥门诊就诊或住院的患儿,以不明原因晕厥及先兆晕厥为主诉,经直立倾斜试验确诊为OHT者为OHT组。与OHT组年龄及性别匹配,选择同期来我院儿童保健门诊检查的健康儿童为对照组。OHT组和对照组均行ABPM监测,观察收缩压昼夜差值、舒张压昼夜差值,24 h、日间、夜间平均收缩压和舒张压参数,并探讨血压类型。结果 OHT组40例,男23例,女17例,年龄(11.5±1.9)岁。对照组40例,男22例,女18例,年龄(10.6±2.4)岁。1收缩压昼夜差值对照组高于OHT组,(9.8±3.3)vs(8.4±4.7)mm Hg,P0.05。OHT组24 h、日间、夜间的平均收缩压和舒张压稍高于对照组(P0.05)。舒张压昼夜差值对照组稍高于OHT组(P0.05)。2OHT组以非勺型血压为主(72.5%),对照组以勺型血压为主(55.0%),两组血压类型差异有统计学意义(P=0.012)。结论 OHT患儿收缩压昼夜差值较正常儿童明显降低,血压类型以非勺型血压多见,多数患儿血压昼夜节律消失。     

Ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring (ABPM) in adults is proving to be useful. The aim of this study was to determine if ABPM is accurate in the lower blood pressure range encountered in children and, equally important, whether it is acceptable to children. Thirty one children, between the ages of 6 and 18 years, were assessed using an ambulatory blood pressure monitor that uses an auscultatory method. Blood pressure was measured in the contralateral arm with a mercury sphygmomanometer and an oscillometric device at the beginning and end of the study for comparison. Over a blood pressure range of 90-130 mm Hg systolic and 40-80 mm Hg diastolic, a close agreement was found with the sphygmomanometer; the limits of agreement (+/- 2 SD) were 11.6 mm Hg for systolic blood pressure and 13.6 mm Hg for diastolic blood pressure. The bias was less than 1.0 mm Hg. The ambulatory device was worn by all patients for at least 16 hours with an average of 52 recordings per patient. The majority found the device comfortable to wear and were not woken from sleep.     

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??Objective To discuss the changes of ambulatory blood pressure monitoring??ABPM?? in children with vasovagal syncope ??VVS??.Methods A total of 72 children ??VVS group??32 males??40 females??mean age ??10.98±1.86??years?? were enrolled in this study??who came from Children Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from Sep 2008 to Feb 2010.After confirmed diagnosis of VVS by positive head-up tilt test ??HUTT????each patient was given ABPM.Forty healthy children ??19 males??21 females??mean age 10.24 ± 2.01 years?? were as controls ??control group??.Parameters of ABPM in children were analyzed.SPSS 17.0 software was used for the statistical analysis of these data.Results ??1??Mean pressure??24-hour mean systolic pressure ??24hSBP????24-hour mean diastolic pressure ??24hDBP????daytime mean systolic pressure ??DSBP?? and nighttime mean systolic pressure ??NSBP?? in VVS group were higher than those of the control group ??P??0.05??.??2??Blood pressure pattern??the ratio of non-spoon pressure pattern was higher than that of spoon pressure pattern with VVS ??67%vs.18%??P ??0.05??.NDBP ??P??0.05?? and NSBP ??P ??0.05?? were decreased and the systolic pressure differences and diastolic pressure differences in the daytime and at nighttime were higher in spoon pressure pattern than those of non-spoon pressure pattern with VVS ??P??0.05??.??3??Diagnostic experimental evaluation??the specificity??sensitivity??diagnostic coincidence??positive predict value and negative predict value of non-spoon pattern of ambulatory blood pressure pattern to VVS was 82.5%??66.67%??72.32%??87.27% and 57.89%??respectively.The Youden index was 45.28%.Conclusion There is autonomic nerve adjustment imbalance in children with VVS during asymptomatic time periods??especially the sympathetic nerve.The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children is higher??which is of diagnosis value to VVS children.     

Home blood pressure monitoring in diabetes.

Forty three children with diabetes were recruited to evaluate home blood pressure monitoring using an electronic oscillometric sphygmomanometer (Philips HP5330). This device was found to be simple to use and reliable. It fulfilled the accuracy criteria of the American Association for the Advancement of Medical Instrumentation for both systolic and diastolic blood pressure and those of the British Hypertension Society for systolic blood pressure. Thirty eight children successfully measured their own blood pressure at home and taught other family members to do the same. The results indicate that home blood pressure monitoring is of value in the management of diabetic children.     

Ambulatory blood pressure monitoring in children and adolescents. Current insights into a new technique

Ambulatory blood pressure monitoring (ABPM) is a new technique recently introduced into paediatrics. Devices with auscultatory blood pressure measurement may be more precise but give more erroneous readings than those with oscillometric measurement. For the interpretation of the results, mean day- and night-time values should be calculated according to patients' diaries and gender- and height-specific percentiles for ABPM measurements should be used to define hypertension. The use of "blood pressure load" as the percentage of single readings above a given upper level is not standardised in children and adolescents. A nocturnal blood pressure decline of less than 10% is defined as "non-dipping", although this is an arbitrary definition whose prognostic value is not evaluated in paediatric patients. Several studies showed that ABPM in children is superior in detecting "white-coat'-hypertension, shows a better reproducibility and is a better prognostic factor for left ventricular mass compared to casual blood pressure measurements. Clinical studies show the value of ABPM in obese children, in children with renal diseases, on dialysis therapy and after renal transplantation as well as in diabetic children or in children after surgical repair of aortic coarctation. Ambulatory blood pressure monitoring in children and adolescents has grown to a valuable method for the daily management of patients with suspected or established hypertension. However, there is still a lot of work before all technical problems are solved and international guidelines can be published which are based on evidence from follow-up studies.