Random-zero sphygmomanometer, Rose's tape, and the accuracy of the blood pressure measurements in children.

In the Cardiovascular Risk in Young Finns project, blood pressure (BP) was measured in 3549 randomly selected children aged 6-18 y in 1980, and 2887 and 2500 of the same individuals in 1983 and 1986, respectively. An ordinary mercury sphygmomanometer (OMS) was used in the first two surveys and a random-zero sphygmomanometer (RZS) in the third survey. Systolic and diastolic BP were lower when measured with an RZS than with an OMS and the shape of the age-related BP curve obtained with an RZS was significantly different from that obtained with an OMS, because low BP values were apparently measured more accurately with the former. Use of the RZS did not affect the distribution of the BP values. Rose's tape readings were used to evaluate the effect of training and to control the accuracy of the BP measurements. According to Rose's tape readings, Korotkoff's 4th phase BP was more difficult to measure accurately than 5th phase (p = 0.002). The mean values for the differences between the correct and actual BP readings on the Rose's tape were -1.2 mm Hg (SD 2.1) for systolic BP, 8.3 mm Hg (SD 13.6) for diastolic Korotkoff's 4th phase BP, and 1.2 mm Hg (SD 7.0) for diastolic Korotkoff's 5th phase BP, with a negative value indicating that the BP phase was measured lower than the correct value. Terminal digit preference was present in each survey to such an extent that it could have hampered the reaching of reliable conclusions from the data obtained with an OMS. The bias caused by terminal digit preference was obviated by the RZS.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of Dinamap 8100 with sphygmomanometer blood pressure measurement in a prepubertal diabetes cohort

OBJECTIVE: To compare the conventional sphygmomanometer with the semiautomated Dinamap 8100 (Critikon, Tampa, FL, USA) for the measurement of blood pressure in prepubertal children with insulin-dependent diabetes mellitus. METHODOLOGY: Blood pressure was measured using both methods in 61 prepubertal children (aged 8-13 years) on 189 occasions over 4 years. The measurements were compared using the Bland-Altman plot. Tracking correlations of blood pressure centiles over time were analyzed by the general estimating equation. RESULTS: Accuracy criteria of the Association for the Advancement of Medical Instrumentation were met and a British Hypertensive Society 'B' grading was reached. Differences in systolic and diastolic blood pressure were found between the two methods (P < 0.01). For systolic blood pressure, common correlations were 0.54 (Dinamap) and 0.51 (sphygmomanometer) and for diastolic blood pressure were 0.33 and 0.42, respectively. CONCLUSION: The Dinamap 8100 is an acceptable alternative in clinic practice and research for prepubertal children.     

Accuracy of blood pressure measurement by the Dinamap monitor in infants and children

Indirect BPs measured by the Dinamap monitor, an oscillometric device, and the conventional auscultatory method were compared with the direct radial artery pressure in infants and children. There were 29 patients in the Dinamap group with a median age of 18 months (ranges 1 month to 16 years) and 20 patients in the auscultatory group with a median age of 3.5 years (ranges 3 months to 16 years). The direct radial artery pressures were recorded on a strip chart and the ranges of pressures were obtained for systolic, diastolic, and mean pressures. The range of the direct readings was converted to a weighted single reading, and comparisons were made between the direct and indirect readings. The linear regression equation between the direct (x) and the Dinamap (y) readings (with correlation coefficient) was y = 1.05x - 5.36 (r = .97) for systolic, y = 1.10x - 4.65 (r = .903) for diastolic, and y = 1.06x - 4.21 (r = .917) for mean pressures. The linear regression equation (with correlation coefficient) for the auscultatory pressure was y = 1.60x - 68.23 (r = .872) and y = 1.38x - 16.47 (r = .874) for diastolic pressures. The error was defined as the indirect reading minus the direct reading. The mean error +/- SD was -0.24 +/- 3.26 for systolic, 1.28 +/- 4.74 for diastolic, and 0.10 +/- 4.56 mm Hg for mean pressures by the Dinamap method. It was -1.65 +/- 6.68 for systolic, and 8.70 +/- 5.97 for diastolic pressures by the auscultatory method.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Non-invasive oscillometric measurement of systolic,mean and diastolic blood pressure in infants with congenital heart defects after operation. A comparison with direct blood pressure measurements

The accuracy of indirect oscillometric blood pressure measurements has been evaluated in 32 infants up to 11 months of age undergoing heart surgery. In a number of 1029 simultaneous measurements the indirect blood pressure was compared with the direct value obtained from a radial artery catheter. Cuffs of different sizes were applied. The main results were as follows: (1) Regarding the ratio of cuff width to arm circumference, the best correlation between oscillometric and direct blood pressure measurements was obtained with a ratio of 0.38–0.41. (2) The value of indirect blood pressure measurements depends on the absolute height of the blood pressure. In low blood pressure there is a tendency to underestimate and in high blood pressure there is a tendency to overestimate by the oscillometric blood pressure measurement.By applying an appropriate cuff size and by using our diagrams it should be possible to derive a direct value for the blood pressure on the basis of indirect oscillometric blood pressure measurements.Abbreviations BP blood pressure - BPM blood pressure measurements - CW/ArmC cuff width to arm circumference ratio - DAP diastolic arterial pressure - MAP mean arterial pressure - SAP systolic arterial pressure - ME mean error - SD standard deviation Research fellow supported by the A. v. Humboldt Stiftung     

Maternal preeclampsia predicts elevated blood pressure in 12-year-old children: evaluation by ambulatory blood pressure monitoring

Ambulatory blood pressure (ABP) monitoring offers a reliable method for determining blood pressure (BP) in children. The aim of this cohort study was to examine whether maternal preeclampsia is associated with elevated BP in an offspring. The study population consisted of 57 children born to preeclamptic mothers (PRE) and their 57 age- and sex-matched control subjects born to normotensive mothers (non-PRE). We examined the 24-h ABP at 12 y of age in the PRE and non-PRE children. Within the two groups, the association of anthropometric measures, plasma catecholamine (epinephrine [E], norepinephrine [NE]) concentrations, and ABP was examined. The PRE children had significantly higher mean 24-h systolic and diastolic ABPs than the non-PRE children. The same was true for the mean daytime and nighttime systolic and diastolic ABPs. The PRE boys had higher 24-h systolic ABP than the PRE girls. In the PRE children, high plasma E concentration and being born small for gestational age (SGA) predicted high systolic 24-h ABP in logistic regression analysis. In the non-PRE children, high current body mass index (BMI) and high plasma E concentration was associated with high systolic 24-h ABP. In conclusion, systolic and diastolic ABP values were elevated in the PRE children. High plasma E concentration and being born SGA were associated with high systolic 24-h ABP in the PRE children. Presumably maternal preeclampsia affects offspring via several mechanisms, including genetic ones and metabolic consequences of restricted intrauterine growth.     

L-arginine infusion lowers blood pressure in children.

Eleven children were studied during L-arginine infusion. Blood pressure decreased, and mean plasma L-arginine and L-citrulline increased compared with baseline levels. The change in blood pressure was inversely related to the change in plasma L-citrulline. These results suggest that L-arginine decreased blood pressure via increased nitric oxide production.     

Diet and blood pressure in children

PURPOSE OF REVIEW: The prevalence of hypertension among children in the US is increasing in concert with rising obesity rates. Leading health organizations agree that elevated blood pressure should be managed in children; however, data on the relation between diet and lifestyle and blood pressure in this age group are sparse and controversial. The purpose of this review is to summarize the current evidence regarding nutrients, foods, and dietary patterns and their role in blood pressure elevation and in the treatment of pediatric hypertension. RECENT FINDINGS: There is clear evidence that avoidance of excess weight gain in early life is important for the prevention of future hypertension and that weight reduction is an important therapeutic intervention for the prevention and treatment of hypertension in overweight children. Similarly, reduction in dietary sodium may be beneficial for children who are salt sensitive, but this trait cannot be easily measured. Children who were breast-fed or consume a diet rich in fruits, vegetables, and dairy foods tend to have lower blood pressure in adolescence. How these foods lower blood pressure is unclear. SUMMARY: Data supporting the efficacy of dietary interventions for preventing or treating high blood pressure are limited. Future studies should emphasize adequate sample size, adjustment for confounding factors, use of standardized blood pressure techniques, and random assignment of children in intervention trials. Additionally, because adherence to dietary interventions may be particularly problematic among children, innovative nutrition intervention approaches are needed that address the unique needs and circumstances of this age group.