Twenty-four-hour ambulatory blood pressure profiles in liver transplant recipients

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has proven to have better reproducibility than office blood pressure (BP) and is increasingly used for the study of hypertension in children and adolescents. The aim of our study was to assess 24-h BP profiles and to compare the results of office BP measurements with ABPM in stable liver transplant recipients transplanted before the age of 18 yr. ABPM was performed in 29 patients (nine males, 20 females), aged 3.9-24.8 yr (median 10.8 yr). The investigation was conducted 1.1-11.5 yr (median 5.1 yr) following transplantation. ABPM confirmed hypertension in one out of three office hypertensive patients. Seven patients (24%), whose office BP recordings were within the normotensive range, were reclassified as hypertensive. Non-dippers (n = 17), arbitrarily defined as patients with less than 10% nocturnal fall in BP, were similarly distributed among patients with ambulatory normotension and ambulatory hypertension (chi(2), p = 0.79). In addition, non-dippers showed a negative correlation between 24-h total urinary albumin excretion and both systolic and diastolic nocturnal decline in BP (Rho = -0.48, p < 0.05 and Rho = -0.86, p < 0.01, respectively). Our study found office BP readings to be poorly representative of 24-h BP profile. Larger studies are needed to confirm our observations as well as to determine whether routine BP measurements in the follow-up of paediatric liver transplant recipients should be based solely on office BP.     

Home blood pressure in children and adolescents: a comparison with office and ambulatory blood pressure measurements

Aim: To compare BP measurements of children and adolescents using different methods office BP (OBP), ambulatory BP monitoring (ABPM) and home BP measurement (HBPM) and to study their correlations. Method: Individuals were evaluated between 5 and 15 years of age who had been referred because of a previous high BP. OBP was measured with the OMRON‐705CP. Three measurements were carried out at 5‐min intervals. HBPM were taken using the same device, two measurements at 5‐min intervals in the morning and in the evening during 7 days. ABPM was performed using the SpaceLabs 90207 monitors. Results: A total of 109 children and adolescents were evaluated (9.82 ± 2.63 years), 52.3% boys, 56.9% non‐white. The office systolic BP (SBP) was lower than in daytime ABPM (p < 0.001) but similar HBPM (p = 0.294), and the office diastolic BP (DBP) was lower than daytime ABPM (p < 0.001) and in HBPM (p = 0.035). The SBP and DBP at HBPM was lower than daytime ABPM (p < 0.001). Daytime ambulatory BP was more closely associated with home readings (SBP r = 0.731 and DBP r = 0.616) than with office’s readings (SBP r = 0.653 and DBP r = 0.394). Conclusion: The BP of children and adolescents varies depending on the place and manner of measurement. ABPM presents better correlation with HBPM than with the office measurements.     

Ambulatory blood pressure monitoring in children with unilateral multicystic dysplastic kidney

Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arterial hypertension is a potential complication of MCDK. Blood pressure (BP) has so far been measured only casually and the frequency of hypertension has been estimated to be between 0%–8%. Ambulatory blood pressure monitoring (ABPM) provides more precise information on BP than the casual BP measurement. The aim of this study was to investigate the BP profile in children with MCDK using ABPM. A group of 25 children (16 girls), with a mean age of 7.8 years (range 3.8–17.7 years) were investigated. ABPM was performed using the oscillometric SpaceLabs 90207 device. Hypertension was defined as mean systolic and/or diastolic BP during the day and/or in the night exceeding 95th percentile for ABPM. Five (20%) children showed hypertension, two of them had combined daytime and night-time hypertension and three had isolated nocturnal hypertension, although daytime BP was between the 90th–95th percentile in two of them. Children with ultrasonographical and/or laboratory signs of contralateral kidney abnormalities showed a higher incidence of hypertension than those without abnormalities (two of four versus 3 of 21). The mean night-time systolic and diastolic BP of children with MCDK was significantly higher than in healthy children (+0.50 and +0.54 SDS, respectively, P=0.012 and 0.03, respectively). Three of the hypertensive children were already nephrectomised. All five hypertensive children showed ultrasonographical and/or laboratory signs of contralateral kidney abnormalities. Hypertensive children had significantly higher microalbuminuria than normotensive children (6.9 ± 3.2 mg/mmol creatinine versus 1.8 ± 0.7, P=0.03). The nocturnal BP fall (dip) was attenuated in five children, only one of whom was hypertensive. Conclusion Arterial hypertension in children with multicystic dysplastic kidney is seen more often if based on ambulatory blood pressure monitoring than on casual blood pressure recordings. The main risk factor for developing hypertension is contralateral kidney damage. Ambulatory blood pressure monitoring should be performed in children with multicystic dysplastic kidney, especially in those with contralateral kidney abnormalities. Received: 20 July 1999 and in revised form: 27 November 1999, 24 March 2000, 3 May 2000 Accepted: 3 May 2000     

White coat hypertension in children with elevated casual blood pressure

OBJECTIVE: We reviewed our experience using ambulatory blood pressure monitoring (ABPM) in children referred to a hypertension clinic to determine the frequency of pediatric white coat hypertension (WCH). STUDY DESIGN: WCH was defined by 3 different diagnostic criteria: (1) mean 24-hour blood pressure (BP) less than Task Force-defined 95th percentile, (2) mean 24-hour BP less than 95th percentile from pediatric normative ABPM data, and (3) mean 24-hour BP less than ABPM 95th percentile and BP load (percentage of BP readings during 24-hour period exceeding the 95th percentile) less than 25%. RESULTS: Clinic BP values were available in 67 otherwise healthy children who underwent ABPM; 51 had confirmed clinic hypertension by Task Force criteria. WCH frequency in these 51 patients with the stated criteria was 53%, 45%, and 22%, respectively. Elevated BP load was found in 52% (12/23) of patients with normal mean BP. CONCLUSION: These results suggest that many children referred for casual BP elevation have WCH even by strict diagnostic criteria. ABPM may help differentiate WCH from persistent hypertension, thereby avoiding unnecessary diagnostic evaluation and identifying children most likely to benefit from early intervention.     

Abnormal circadian blood pressure regulation in liver transplanted children

HT is a frequent cardiovascular risk factor in liver transplant recipients. However, there are only few studies in the literature regarding the risk of HT in liver transplanted children. The aim of this study was to assess the 24 h BP profiles of liver transplanted patients and to compare the results with healthy children. ABPM was performed on 20 liver transplanted patients and 27 healthy children aged 7.1 ± 4.8 and 8.5 ± 2.9 yr, respectively. HT was defined as SDS > 1.64 (i.e., >95th percentile) adjusted for gender and height. The mean duration of post-transplant follow-up was 32 ± 19 months. Six (30%) patients were found to be hypertensive. The physiological nocturnal BP fall was attenuated significantly in the study group for diastolic BP (11.5 ± 6.1 mmHg vs. 17.7 ± 7.1 mmHg, p = 0.006). Specifically, the number of patients with high nighttime systolic and diastolic BP SDS (p = 0.02 and p = 0.004, respectively) as well as elevated nighttime systolic (p = 0.03) and diastolic (p = 0.003) BPLs was found to be significantly higher than those in the controls. Alteration of the "normal" circadian rhythm is very frequent in liver transplant recipients. Thus, it is recommended to perform ABPM on all liver transplanted children not to underdiagnose HT.     

24-hour ambulatory blood pressure profile in patients with congenital adrenal hyperplasia--a preliminary report

BACKGROUND: Blood pressure (BP) is maintained within normal limits by the interplay of various mechanisms including the action of cortisol and aldosterone. However, these hormones when exogenously administered are not under the regulatory feedback mechanisms that maintain BP homeostasis. Treatment of congenital adrenal hyperplasia (CAH) requires glucocorticoid replacement (with or without additional mineralocorticoid) at supra-physiological doses to normalize the pituitary adrenocortical axis. HYPOTHESIS: Long-term use of glucocorticoids at supra-physiological doses may result in high BP. OBJECTIVE: To document any changes in BP in patients with CAH following long-term conventional glucocorticoid replacement therapy. PATIENTS AND METHODS: 24-hour ambulatory BP (AmBP) monitoring was performed in 11 patients with CAH, all of whom were on glucocorticoid replacement at supra-physiological doses. In addition, a single random BP measurement was taken in each patient at enrolment. Mean systolic and diastolic pressure during awake and sleep periods, systolic and diastolic BP loads, and systolic and diastolic BP dips were calculated from the 24-hour AmBP profile of each patient, which was correlated with demographic and treatment details. AmBP readings were compared to Task Force references for casual BP and also to recently available AmBP specific reference values. RESULTS: None of the patients had significant BP loads at the 95th percentile (hypertensive BP range) using references for casual BP readings. However, in the subgroup of patients who had significant BP load at the 90' percentile (high normal BP range), higher mean systolic and diastolic pressures were noticed during the awake period. Seven patients did not have a systolic dip with or without a diastolic dip. There was no significant correlation between various BP parameters and demographic or treatment details in our sample. However, one patient had daytime systolic hypertension and six had nocturnal hypertension using AmBP specific reference values. CONCLUSIONS: In this preliminary study, longterm glucocorticoid replacement therapy at supra-physiological doses does not seem to be associated with hypertension in young people with CAH when using casual BP references. However, higher mean BP was noticed in the subgroup of patients with significant systolic or diastolic BP load at high normal BP range, and evidence of daytime and nocturnal hypertension was uncovered using AmBP specific reference values. Further large trials using appropriate BP references are necessary to clarify the significance of these findings.     

BLOOD PRESSURE IN CHILDREN AND ADOLESCENTS

Abstract. Blood pressure (BP) levels were recorded in 2 223 male and 2 205 female children and adolescents ranging in age from 7 to 18 years. In addition, 521 male adults (soldiers) ranging in age from 21 to 25 years were included in the study. Children and adolescents who participated in the survey were selected at random from the Elementary and High Schools. The results of the study showed that a gradual increase occurred in the systolic, as well as in the diastolic component of blood pressure from 7 to 18 years of age. By contrast, there was no increase with age in the systolic and diastolic blood pressure in the young male adult subjects, who had BP measurements comparable to those observed in children. A child was characterized as hypertensive according to the criteria outlined by Master et al. Children with BP between the 90th and the 95th percentile were considered as suspect hypertensive, whereas those with BP exceeding the 95th percentile were considered definitely hypertensive. The overall incidence of hypertension in children in this survey was 3.1%.     

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。     

Delivery room blood pressure percentiles of healthy,singleton, liveborn neonates

Background: Arterial blood pressure (BP) is one of the four vital signs that reflect cardiovascular status in neonates. The present study aimed to obtain BP percentiles among healthy, singleton, liveborn neonates between 34 and 43 weeks of gestation who were less than 1 h old. Methods: BP measurements were taken after birth in supine‐positioned neonates in the delivery room using an oscillometric device. A total of 982 well‐nourished neonates who did not require resuscitation, were not fetally malnourished, were not admitted to the neonatal intensive care unit and were without obvious congenital abnormalities were included in the study. Results: Sex‐ and type‐of‐delivery‐specific 5th and 95th percentiles BP measurements were obtained for gestation. Mean BP values for systolic, diastolic and mean of term neonates were 63.98 ± 12.29 mmHg, 38.34 ± 11.06 mmHg and 49.32 ± 11.33 mmHg, and late preterm neonates were 61.80 ± 12.46 mmHg, 33.17 ± 9.97 mmHg and 46.52 ± 10.8 mmHg, respectively. There were weak but significant correlations between birthweight, birth length and head circumference and systolic, diastolic and mean arterial BP values (r = 0.20, r = 0.15 and r = 0.20, respectively, P < 0.001). Neonates who were delivered vaginally had higher mean BP values for systolic, diastolic and mean than neonates delivered by cesarean section (P < 0.05). Female neonates had higher systolic BP values than male neonates (P < 0.05). Conclusion: Data presented in this study include sex‐ and delivery‐mode‐specific BP percentile curves using an oscillometric method and serve as a valuable reference for physicians in dealing with the management of singleton, liveborn late preterm and term newborns in the delivery room intensive care.     

Circadian blood pressure changes in untreated children with kidney disease and conserved renal function

Abstract Ambulatory blood pressure monitoring over 24 h was applied in 31 children with kidney disease, aged 3–19 (median 11) years, in the absence of renal insufficiency and without antihypertensive therapy. Median creatinine clearance was 112ml/min/1.73m². Ambulatory blood pressure monitoring revealed that eight patients (26%) were hypertensive during the daytime, compared to 62% through casual recordings obtained in the office and 38% when blood pressure was taken at home. Nocturnal hypertension was detected by ambulatory monitoring in six patients, two of whom had normal blood pressure in the daytime. Median nocturnal dipping was 13% for systolic and 21% for diastolic blood pressure, i.e. similar to healthy children. Rhythm analysis recognized a distorted circadian pattern for systolic and/or diastolic blood pressure in eight patients. In conclusion, ambulatory blood pressure monitoring allows the evaluation of hypertension more reliably than casual recordings in the office. Nocturnal hypertension, as a major risk factor for renal deterioration, is detected in a similar proportion as daytime hypertension in almost 20% of untreated children with kidney disease and normal renal function.     

Twenty-four hour monitoring of blood pressure and heart rate in patients with chronic renal failure or renal transplant recipients: Analysis by the cosinor method

Hypertension is a major problem of patients with chronic renal failure or renal transplant recipients. To clarify the characteristics of blood pressure, heart rate, and circadian rhythms of these patients we used an ambulatory blood pressure monitor (ABPM) for 24 h monitoring and analyzed the data by the cosinor method. In eight chronic renal failure patients without dialysis the midline estimating statistic of rhythm (MESOR) of diastolic blood pressure was higher than in controls, but the MESOR of systolic blood pressure was not. Of 11 patients on dialysis some had hypertension and some had hypotension. In 14 renal transplant recipients, especially those with chronic graft rejection, the MESOR of systolic and diastolic pressures were higher than controls, and the increase of blood pressure MESOR had a significant correlation with the elevation of serum creatinine levels. Circadian rhythms of blood pressure were frequently absent in the patients on dialysis, but circadian rhythms of heart rate were not. The use of an ABPM is a non-invasive method to monitor patients and allowed us to know changes of blood pressure and heart rate in the daytime as well as during the night. For the control of hypertension in chronic renal failure, monitoring with an ABPM seems to provide invaluable information.     

Home blood pressure self-measurement in children and adolescents with renal replacement therapy

BACKGROUND: Most patients with terminal renal failure show arterial hypertension. In addition to casual blood pressure measurements in the clinic, home blood pressure measurement is recommended for these patients to control arterial blood pressure. PATIENTS: The study was performed in children with hemodialysis (HD; n = 11), peritoneal dialysis (PD; n = 14) or after renal transplantation (NTX; n = 21) from one department of Pediatric Nephrology. We performed a retrospective analysis of home blood pressure values from patients' diaries. METHODS: The average number of blood pressure measurements per day and the mean blood pressure values were calculated from the blood pressure data documented during one month at home. Single measurements above the 95th percentile for height and gender were defined to be hypertensive and the frequency as percentage of all documented values was calculated. RESULTS: Four patients did not document any blood pressure values at home. The other patients documented an average of 2.3 measurements per day. Systolic hypertension was found in 7% of patients defined by home BP measurements compared to 30% defined by casual BP measurements. Prevalence of diastolic hypertension did not differ between both methods (35% vs. 46%). Mean home BP was significantly higher than values after HD and lower than values before HD. Mean clinic BP was significantly higher in PD-patients compared to home BP. Home and clinic blood pressure values did not differ in patients after renal transplantation. The mean percentage of hypertensive readings for systolic BP was 5 and for diastolic BP 39%. CONCLUSIONS: Blood pressure measurement at home is performed reliably by most children and adolescents with chronic renal failure and shows lower values than clinic BP in many patients. It is an important method for control of blood pressure and a valuable supplement to 24 h blood pressure monitoring.     

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.     

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。     

Reliability of the Dinamap non-invasive monitor in the measurement of blood pressure of ill Asian newborns

Four hundred thirty-one paired sets of readings of systolic and diastolic blood pressure and 438 paired sets of readings of mean arterial BP from 49 ill newborns, including 21 very low birth weight infants, were analyzed for the extent and pattern of agreement and the linear relationship between the Dinamap oscillometric monitor and the direct intraarterial blood pressure readings. Agreement between the two methods was measured by the intraclass correlation, whereas the linear relationship was assessed by the product-moment correlation. The intraclass correlations for systolic, diastolic and mean blood pressures were 0.696, 0.766, and 0.781, respectively. The product-moment correlations for systolic, diastolic and mean blood pressures were 0.706, 0.768, and 0.786, respectively. BP measurements by the Dinamap monitor showed reasonably close agreement to those obtained by the intraarterial mean arterial pressure ranges above 40 mmHg. For mean arterial pressure of 40 mmHg and lower, BP readings by the Dinamap monitor tended to be higher than those obtained by the intraarterial method. These findings appeared to be consistent regardless of the birth weight of the newborn.     

Ambulatory blood pressure in patients with occult recurrent coarctation of the aorta

The hypothesis that mild recurrent aortic obstruction produces subtle changes in ambulatory blood pressure was investigated by performing 24-hour monitoring on 11 postoperative coarctation patients. Patients (age 16.1±2.7 years) were compared with normal controls (age 15.7±2.5 years,n=15). Surgery (end-to-end anastomosis) was performed at 6.0±1.0 years of age. There were no significant differences between patients and controls in terms of baseline blood pressure (right arm 123/78±4/3 mmHg versus 120/75±3/2 mmHg) or right leg systolic pressure (125±6 mmHg versus 123±4 mmHg). Of the 11 patients 8 had recoarctation by Doppler study (mean gradient 25.3±2.1 mmHg), 5 of 11 had a postexercise arm-leg pressure difference of>30 mmHg, and 6 patients had aortic diameters at the site of surgery <70% of the descending aortic diameter (by magnetic resonance imaging). There were no significant differences between the coarctation and control groups in terms of mean ambulatory systolic (125±3 mmHg versus 119±2 mmHg) or diastolic (69±2 mmHg versus 72±2 mmHg) pressures throughout the day. However, coarctation patients had a larger number of systolic pressures that exceeded the 95th percentile (18.2±5.6% versus 6.8±1.2%). These labile increases in systolic pressure correlated with residual coarctation (r=0.642,p=0.003). Ambulatory monitoring is a useful tool for detecting and monitoring subtle abnormalities of blood pressure control after coarctation repair.     

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.     

Longitudinal data of blood pressure and pulse frequency during childhood (author's transl)

From 1968-1980 the development of blood pressure and pulse frequency in 221 healthy boys and 230 healthy girls aged 2-16 years was studied longitudinally. An automatic blood pressure device recording on a paper tape pulse frequence as well was used. Systolic readings are taken at the first appearance, diastolic readings at the disappearance of the Korotkoff sounds. A steady increase of the systolic, and to a lesser extent, of the diastolic pressure can be observed. Boys have a more pronouned increase of systolic pressure than girls. From year 2-16 the 50th percentile increases from 90 mm Hg to 128 mm Hg in boys and from 92 mmHg to 116 mm Hg in girls. The 50th percentile of diastolic pressure increases from 61 to 66 mm Hg in boys and 65 to 71 mm Hg in girls. Pulse frequency of boys is comparable to that of girls. The 50th percentile decreases from 100 to 75 beats. Increasing age is paralleled by decreasing pulse frequency.     

Is ABPM clinically useful after pediatric solid organ transplantation?

When ambulatory blood pressure monitoring (ABPM) is performed in populations with a high risk for secondary hypertension, such as solid organ transplant recipients, hypertension or abnormalities in circadian blood pressure variability are often discovered even in patients with normal office blood pressure (BP). To discuss whether ABPM should be routinely assessed in pediatric solid organ recipients, the available information on pathological findings, association of ABPM abnormalities with outcome parameters, and treatment options is reviewed. ABPM is a useful tool to optimize therapy in the large proportion of transplant recipients with confirmed hypertension. Whether the use of ABPM on a routine basis should be recommended for pediatric transplantation patients without office hypertension remains to be determined.     

Arterial HTN in children with T1DM—frequent and not easy to diagnose

Introduction: To evaluate the diagnostic efficacy of the office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension (HTN) in children with diabetes mellitus type 1 (T1DM).
Methods: We analyzed OBP and ABPM measurements in 84 diabetic children (43 boys) obtained at a median age of 14.9 yr and 6.3 ± 3.5 yr after diagnosis of T1DM. OBP and ABPM results were converted into standard deviation scores (SDS). In addition, we analyzed blood pressure loads and nighttime dipping. The comparison between OBP and ABPM was performed using kappa coefficient and receiver operator curve (ROC).
Results: HTN was diagnosed in 43/84 (51%) patients using OBP (>95th percentile), and in 24/84 (29%) patients using ABPM ( ≥95th percentile during 24 h, day or night). Both methods were in agreement in 33 ABPM normotensive and 16 ABPM hypertensive patients (most had nighttime HTN); 32% patients had white-coat HTN and 9.5% patients had masked HTN. The kappa coefficient was 0.175 (95% CI from −0.034 to 0.384) suggesting poor agreement between OBP and ABPM. Diastolic OBP was a better predictor of ABPM HTN (ROC area under the curve (AUC) = 0.71 ± 0.06) than systolic OBP (AUC = 0.58 ± 0.07). The percentage of non-dippers ranged from 7 to 23% in ABPM normotensive patients, and 21–42% in ABPM hypertensive patients who also had significantly higher BP loads (p < 0.0001).
Conclusion: Children with T1DM often suffer from nocturnal, white coat- and masked HTN, which can not be assessed and predicted by the OBP.