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.     

动态血压在儿科的应用

动态血压监测能真实反映患者24h血压的平均水平、日常生活的血压变化和昼夜节律变化,较传统的血压监测有明显的优势.研究已经确定其在识别儿童白大衣性高血压及隐匿性高血压、预测靶器官损害、评价降压药物疗效、鉴别原发性高血压及继发性高血压等方面有一定价值.该文简述动态血压监测在儿科的临床应用.     

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 pediatric renal transplantation

Over last two decades ABPM has evolved from a research device to an established and valuable clinical tool for BP evaluation. More than 10 yrs ago ABPM was introduced to pediatrics and since that time, its importance has been increasing in the management of hypertension in children and adolescents. This review summarizes the information gathered from the studies of ABPM in adult and pediatric patients with renal transplants. We will review the importance of hypertension in this patient subset, discuss the advantage of ABPM over CBP and focus on specific abnormalities and clinical significance of ABPM in renal transplant recipients.     

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.     

Ambulatory blood pressure in schoolchildren.

OBJECTIVE: To define the range and variability of ambulatory blood pressure in normal schoolchildren. DESIGN: Prospective study. METHODS: Resting blood pressure of 1121 schoolchildren from Newcastle upon Tyne was recorded. An ambulatory blood pressure device, which uses both auscultatory (Korotkoff) and oscillometric methods of blood pressure measurement, was then put in place for 24 hours. RESULTS: The day was divided into three time periods: school, home, and night time. Normal centiles for blood pressure for each of these time periods were obtained and many daytime readings were outside reported normal resting levels. The normal variation of blood pressure was quantified by comparing each of these time periods with the resting readings. Resting systolic blood pressure did not predict 24 hour mean systolic blood pressure. CONCLUSIONS: The availability of normal ambulatory blood pressure data on the level and variation of blood pressure in children may facilitate the early identification of hypertension in this age group.     

动态血压监测在儿童肾脏疾病中的临床研究

目的 研究儿童肾脏疾病中的动态血压(ABP)的特点.方法 以33例肾脏疾病患儿为研究对象,采用ABPM6100仪进行动态血压测量(ABPM),受试对象均未服用降压药物.以1997年德国1141名健康儿童的ABP值作为正常参考值.结果 夜间高血压发生率高于日间高血压发生率;夜间收缩/舒张压负荷(29.1±34.5)%/(24.9±34.3)%和指数(0.95±0.11)/(0.90±0.18)明显大于日间收缩/舒张压负荷(12.9±23.6)%/(9.3±19.1)%和指数(0.88±0.09)/(0.77±0.12);肾脏疾病患儿夜间收缩/舒张压下降率为(6.6±6.0)%/(8.8±10.2)%,明显低于正常值(13±6)%/(23±9)%;高达24例(72.7%)患儿夜间收缩压和(或)舒张压下降率为"非杓型",即使在正常血压者中也有72.7%的"非杓性"发生率.在33例患儿中随机血压(CBP)升高者5例,均有ABP升高;CBP正常者28例,但其中6例ABP升高.结论 ABPM能发现儿童肾脏疾病中的夜间高血压和血压昼夜节律的异常,为调整用药时机和更全面有效地控制血压提供依据,弥补了传统血压测量的不足;并能发现隐匿性高血压,可以早期发现高血压前期,从而有利于随访和尽早干预.     

Ambulatory blood pressure monitoring: what a pediatrician should know

PURPOSE OF REVIEW: Ambulatory blood pressure monitoring is a useful tool for the evaluation and management of hypertension in children and adolescents. This review provides a basic overview of ambulatory blood pressure monitoring and summarizes the most recent available knowledge regarding its use in the pediatric population. RECENT FINDINGS: Evaluation and validation of ambulatory blood pressure monitoring equipment in children remains limited, although advances in the interpretation of results for this age group have been reported specifically in the area of circadian (24 h) and ultradian (<24 h) variability. Blood pressure is a dynamic phenomenon that varies not only with time but also with changing patient and environmental circumstances. Growing evidence regarding conditions identified when this variability is considered, specifically white coat and masked hypertension, suggests that office blood pressure measurement may not be a sufficient screening test for hypertension-related target-organ damage. SUMMARY: Information regarding ambulatory blood pressure monitoring use in children is increasing, although due to its limitations and expense, it remains a tool primarily utilized by the pediatric sub-specialist.     

Ambulatory blood pressure measurements

Ambulatory blood pressure monitoring (ABPM) has emerged as a valuable clinical and research tool in the assessment of pediatric hypertension. Large databases of 24-hour blood pressure monitorings in healthy children are under development for establishing normal reference values analogous to the Task Force data for casual blood pressure. In the clinical setting, pediatric studies using ABPM to evaluate elevated blood pressure have shown that the prevalence of white coat hypertension in children is similar to that reported in adults. Furthermore, 24-hour blood pressure parameters are correlated with hypertensive end-organ injury such as left ventricular hypertrophy. ABPM has allowed detailed assessment of circadian blood pressure patterns that show early subtle abnormalities in some high-risk groups and normal patterns in other groups previously thought to be at high risk. These studies will assist in the practice of evidence-based medicine regarding pediatric hypertension that will improve the long-term care that pediatricians provide to their patients.     

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     

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.     

Ambulatory blood pressure monitoring in children with aortic coarctation and kidney transplantation

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) has been found to be of significant importance in clinical practice because numerous blood pressure (BP) measurements may be made throughout the 24-hour period. OBJECTIVE: To assess the clinical utility of ABPM in children with secondary hypertension. METHODS: We studied 37 patients (21 boys and 16 girls), with a mean age of 16.4 +/- 4.1 years, after kidney transplantation and 38 patients (27 boys and 11 girls), with a mean age of 10.2 +/- 2.1 years, after surgical correction of aortic coarctation. Data, expressed as mean +/- SD, were analyzed after dividing the patients into 4 groups. Group A consisted of 25 patients receiving antihypertensive therapy; group B included 12 patients not receiving antihypertensive therapy. Group C included 25 patients operated on before 3 years of age (8 +/- 7 months of age); group D included 13 patients operated on after 3 years of age (74 +/- 29 months of age). RESULTS: In groups A and B, casual BP measurement showed that 16 of 37 patients (43%) were hypertensive; 24-hour ABPM detected a larger number of patients who were hypertensive (23 of 37, 62%); there were 18 in group A and 5 in group B. In groups C and D, casual BP measurement identified 6 of 38 (15%) patients as hypertensive, whereas 24-hour ABPM again identified a higher number (13 of 38, 34%). CONCLUSIONS: Our findings confirm that 24-hour ABPM is more sensitive than casual BP in detecting abnormal BP in patients at high risk for secondary hypertension.