Influence of blood pressure level and age on within-visit blood pressure variability in children and adolescents
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Blood pressure (BP) is variable in children and this could affect BP assessment, but the magnitude of within-visit BP variability (BPV) over consecutive measurements has never been investigated. This study aimed to determine the direction and magnitude of, and factors affecting, within-visit BPV in children and adolescents. BP was recorded among 3047 children (aged 12 years [95%CI 12, 13], males 52%) from the 2011–2013 Australian Health Survey. BPV was defined as the absolute difference (∆SBPABS) between the first (SBP1) and second systolic BP (SBP2) and the overall variability in three measures when available (SBPV). On average, ∆SBPABS was 6.7 mmHg (95%CI 6.3, 7.0) and SBPV was 8.2% (95%CI 7.8, 8.6). ∆SBPABS was greater with higher BP levels but lower with older age. From first to second measurements, SBP decreased in 58% (95%CI 56, 60), did not change in 10% (95%CI 9, 12), and increased in 32% (95%CI 29, 34) of the population.
What is Known:
• Diagnosis of elevated blood pressure (BP) is based on strict probabilistic criteria, the difference between the 90th (pre-hypertension) and 95th (hypertension) percentiles only being 3–4 mmHg.
• BP variability could affect BP classification among children and adolescents.
What is New:
• The magnitude of BP change among children and adolescents is highly affected by BP level and age.
• BP does not always drop on consecutive measurements, and evidence-based BP assessment protocols should be established to avoid misdiagnosis of hypertension.
KeywordsBlood pressure classification Clinic blood pressure Alarm reaction Pediatric hypertension Hypertension guidelines
Australian Health Survey
Blood pressure variability
Body mass index
Diastolic blood pressure
Variability in diastolic blood pressure
Difference between SBP1 and SBP2
Absolute difference between SBP1 and SBP2
First systolic blood pressure
Second systolic blood pressure
Third systolic blood pressure
Variability in systolic blood pressure
Veloudi, P.: Mrs Veloudi contributed to study conception and design, literature review, data analysis and interpretation, manuscript preparation and final approval of the version to be published.
Blizzard, C.L.: A/Prof Blizzard contributed to data analysis and interpretation, critical manuscript revision and final approval of the version to be published.
Schultz, M.G.: Dr Schultz contributed to critical manuscript revision and final approval of the version to be published.
Srikanth, K.V.: Prof Srikanth contributed to critical manuscript revision and final approval of the version to be published.
Sharman, J.E.: Prof Sharman contributed to study conception and design, critical manuscript revision and final approval of the version to be published.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
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