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European Journal of Pediatrics

, Volume 177, Issue 2, pp 205–210 | Cite as

Influence of blood pressure level and age on within-visit blood pressure variability in children and adolescents

  • Panagiota Veloudi
  • Christopher L. Blizzard
  • Velandai K. Srikanth
  • Martin G. Schultz
  • James E. Sharman
Original Article

Abstract

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.

Conclusions: BP is highly variable in children and adolescents, with the magnitude of variability being associated with both age and BP level. SBP increases on repeat measurement in a substantial proportion of the population. The optimal protocol of BP assessment to address this increased BPV needs to be determined.

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.

Keywords

Blood pressure classification Clinic blood pressure Alarm reaction Pediatric hypertension Hypertension guidelines 

Abbreviations

AHS

Australian Health Survey

BP

Blood pressure

BPV

Blood pressure variability

BMI

Body mass index

DBP

Diastolic blood pressure

DBPV

Variability in diastolic blood pressure

ΔSBP

Difference between SBP1 and SBP2

∆SBPABS

Absolute difference between SBP1 and SBP2

PP

Pulse pressure

SBP1

First systolic blood pressure

SBP2

Second systolic blood pressure

SBP3

Third systolic blood pressure

SBPV

Variability in systolic blood pressure

Notes

Authors’ contributions

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

Informed consent was obtained from all individual participants included in the study.

Supplementary material

431_2017_3049_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Panagiota Veloudi
    • 1
  • Christopher L. Blizzard
    • 1
  • Velandai K. Srikanth
    • 1
    • 2
  • Martin G. Schultz
    • 1
  • James E. Sharman
    • 1
  1. 1.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
  2. 2.Department of Medicine, School of Clinical Sciences at Monash HealthMonash Medical CentreMelbourneAustralia

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