AHA issues guidance for ABPM in children, adolescents

8 August 2008

MedWire News: The American Heart Association has published a scientific statement recommending ambulatory blood pressure monitoring (ABPM) in children and adolescents to help diagnose and manage hypertension.

"Clinical hypertension can be identified in children and adolescents and is associated with organ damage even at young ages," said chair of the statement writing group Elaine Urbina (Cincinnati Children's Hospital Medical Center, Ohio, USA). "Accurate diagnosis and early treatment is essential."

She continued: "There is now sufficient experience with ABPM to recommend its use in pediatric patients to assist in diagnosing hypertension."

The statement, published advance online by the journal Hypertension, is expert-opinion driven rather than evidence based because of the lack of data relating ABPM in this age group to hard outcomes. It provides a summary of the current literature and offers guidance on performing ABPM and interpreting results.

The statement indicates that ABPM can be used to distinguish between white coat and true hypertension, detect masked hypertension, evaluate the effectiveness of antihypertensive treatment, and assess BP variability - in particular the dipping status in patients at high risk for end-organ damage, and the severity and persistence of BP elevation.

"Ambulatory monitoring is likely to be most useful in children whose office BP readings are up to 10% over the highest acceptable reading, as children with very high readings (more than 10% higher than the highest reading) were more likely to have true high BP," noted Urbina.

She commented further: "These guidelines help pediatric healthcare providers to understand the use of ABPM in monitoring children's BP. A standard technique advocated by a national organization like the AHA is reassuring to parents who want to be sure that their children are receiving consistent, high-quality care."

Hypertension 2008; Advance online publication