Skip to main content

Ambulatory Blood Pressure Monitoring in Children and Adolescents: Coming of Age?

Current Hypertension Reports volume 15, pages 143–149 (2013)Cite this article

Abstract

Over the last years, ambulatory blood pressure monitoring has been introduced into the pediatric population, contributing to a significant increase in the bulk of knowledge of crucial clinically relevant issues. Guidelines have established the currently known conditions where ambulatory blood pressure monitoring is useful and where it will provide additional information in children and adolescents. How common and important the intra-individual differences are within clinical and ambulatory blood pressure is the keystone to the use of ambulatory blood pressure monitoring as a diagnostic tool. By using not only office, but also ambulatory blood pressure, four possible situations arise. Two of these have values in agreement for normotension or hypertension. Two have values that are discrepant. The latter two are known as white coat and masked hypertension. The relationship with hypertension-induced organ damage, the prognostic value and the assessment of treatment goals are key issues of ambulatory blood pressure monitoring. In children, the accurate identification of hypertension at the earliest possible age would, therefore, give health-care providers the opportunity to initiate preventive measures, thereby reducing the chance of developing end-organ damage and its attendant morbidity and mortality.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Papers of particular interest have been highlighted as: • Of importance •• Of major importance

  1. Lurbe E. Childhood blood pressure: a window to adult hypertension. J Hypertens. 2003;21:2001–3.

    PubMed  Article  CAS  Google Scholar 

  2. Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995;8:657–65.

    PubMed  Article  CAS  Google Scholar 

  3. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke and coronary heart disease. Part I, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765–74.

    PubMed  Article  CAS  Google Scholar 

  4. Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr. 2004;144:7–16.

    PubMed  Article  Google Scholar 

  5. •• National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76. This report was a milestone paper providing clinicians with scientific evidence regarding blood pressure in children and gave recommendations for diagnosis, evaluation, and treatment of hypertension based on available evidence and consensus expert opinion of the working group.

    Article  Google Scholar 

  6. • Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension. 2008;52:433–51. The document summarizes the research and clinical applications of ABPM in children and adolescents and offers recommendations on implementation of ABPM in practice and interpretation of results.

    PubMed  Article  CAS  Google Scholar 

  7. •• Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719–42. These guidelines represent a consensus among specialists involved in the detection and control of high blood pressure in children and adolescents. The document synthesizes a considerable amount of scientific data and clinical experience and represents best clinical wisdom, upon which physicians, nurses, and families should base their decisions. They call attention to the burden of hypertension in children and adolescents and its contribution to the current epidemic of cardiovascular disease.

    PubMed  Article  CAS  Google Scholar 

  8. Lurbe E, Cremades B, Rodriguez C, Torro MI, Alvarez V, Redon J. Factors related to quality of ambulatory blood pressure monitoring in a pediatric population. Am J Hypertens. 1999;12:929–33.

    PubMed  Article  CAS  Google Scholar 

  9. Lurbe E, Redon J, Liao Y, Tacons J, Cooper R, Alvarez V. Ambulatory blood pressure monitoring in normotensive children. J Hypertens. 1994;12:1417–23.

    PubMed  Article  CAS  Google Scholar 

  10. Staessen JA, O’Brien ET, Amery AK, Atkins N, Baumgart P, De Cort P, et al. Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database. J Hypertens. 1994;12 suppl 7:S1–12.

    CAS  Google Scholar 

  11. Pannarale G, Bebb G, Clark S, Sullivan A, Foster C, Coats AJS. Bias and variability in blood pressure measurement with ambulatory recorders. Hypertension. 1993;22:591–8.

    PubMed  Article  CAS  Google Scholar 

  12. Lurbe E, Cremades B, Torró I, Alvarez V, Tacons J, Redón J. Gender modifies the relationship between awake systolic blood pressure and growth in adolescents. Am J Hypertens. 1998;11(part 2):20A.

    Article  Google Scholar 

  13. Lurbe E, Thijs L, Redon J, Alvarez V, Tacons J, Staessen J. Diurnal blood pressure curve in children and adolescents. J Hypertens. 1996;14:41–6.

    PubMed  Article  CAS  Google Scholar 

  14. Staessen J, Bulpitt CJ, O’Brien E, Cox J, Fagard R, Stanton A, et al. The diurnal blood pressure profile. A population study. Am J Hypertens. 1992;5:386–92.

    PubMed  Article  CAS  Google Scholar 

  15. Pickering TG, Harsfield GA, Kleinert HD, Blank S, Laragh JH. Blood pressure during normal daily activities, sleep and exercise. Comparison of values in normal and hypertensive subjects. JAMA. 1982;247:992–6.

    PubMed  Article  CAS  Google Scholar 

  16. Lurbe A, Redon J, Pascual JM, Tacons J, Alvarez V, Batlle DC. Altered blood pressure during sleep in normotensive subjects with type I diabetes. Hypertension. 1993;21:227–35.

    PubMed  Article  CAS  Google Scholar 

  17. • Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens. 2002;20:1995–2007. The study provides distribution-independent reference values for time-integrated 24-h, daytime and nighttime mean values of systolic, diastolic and mean arterial BP, as well as of heart rate, in children.

    PubMed  Article  Google Scholar 

  18. Hornsby JL, Mongan PF, Taylor AT, Treiber FA. ‘White coat’ hypertension in children. J Fam Pract. 1991;33:617–23.

    PubMed  CAS  Google Scholar 

  19. Sorof JM, Poffenbarger T, Franco K, Portman R. Evaluation of white-coat hypertension in children: importance of the definitions of normal ambulatory blood pressure and the severity of casual hypertension. Am J Hypertens. 2001;14:855–60.

    PubMed  Article  CAS  Google Scholar 

  20. Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, et al. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension. 2005;45:493–8.

    PubMed  Article  CAS  Google Scholar 

  21. Lurbe E, Redon J. The role of ambulatory blood pressure monitoring in diagnosis of hypertension and evaluation of target-organ damage. In: Flynn JT, Ingelfinger JR, Portman RJ, editors. Pediatric hypertension. 2nd ed. New Jersey: Humana Press; 2011. p. 517–28.

    Chapter  Google Scholar 

  22. Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N. White-coat and masked hypertension in children: association with target organ damage. Pediatr Nephrol. 2005;20:1151–5.

    PubMed  Article  Google Scholar 

  23. Matsuoka S, Kawamura K, Honda M, Awazu M. White coat effect and white coat hypertension in pediatric patients. Pediatr Nephrol. 2002;17:950–3.

    PubMed  Article  Google Scholar 

  24. McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T, et al. Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension. 2007;50:392–5.

    PubMed  Article  CAS  Google Scholar 

  25. Kavey RE, Kveselis DA, Atallah N, Smith FC. White coat hypertension in childhood: evidence for end-organ effect. J Pediatr. 2007;150:491–7.

    PubMed  Article  Google Scholar 

  26. Lande MB, Meagher CC, Fisher SG, Belani P, Wang H, Rashid M. Left ventricular mass index in children with white coat hypertension. J Pediatr. 2008;153:50–4.

    PubMed  Article  Google Scholar 

  27. Stergiou GS, Nasothimiou E, Giovas P, Kapoyiannis A, Vazeou A. Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring. J Hypertens. 2008;26:1556–62.

    PubMed  Article  CAS  Google Scholar 

  28. Mitsnefes M, Flynn J, Cohn S, Samuels J, Blydt-Hansen T, Saland J, et al. Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol. 2010;21:137–44.

    PubMed  Article  CAS  Google Scholar 

  29. Di Salvo G, Castaldi B, Baldini L, Gala S, del Gaizo F, D’Andrea A, et al. Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function. J Hum Hypertens. 2011;25:739–45.

    PubMed  Article  Google Scholar 

  30. Matsuoka S, Awazu M. Masked hypertension in children and young adults. Pediatr Nephrol. 2004;19:651–4.

    PubMed  Article  Google Scholar 

  31. Bobrie G, Chatellier G, Genes N, Clerson P, Vaur L, Vaisse B, et al. Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004;291:1342–9.

    Google Scholar 

  32. Bjorklund K, Lind L, Zethelius B, Andrén B, Lithell H. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation. 2003;107:1297–302.

    PubMed  Article  Google Scholar 

  33. Lurbe E, Redon J. Assessing ambulatory blood pressure in renal diseases: facts and concerns. Nephrol Dial Transplant. 1999;14:2564–2568.

    Google Scholar 

  34. Luik AJ, Struijk DG, Gladziwa U, von Olden RW, von Hooff JP, de Leeuw PW, et al. Diurnal blood pressure variations in haemodyalisis and CAPD patients. Nephrol Dial Transplant. 1994;9:1616–21.

    PubMed  CAS  Google Scholar 

  35. Farmer CK, Goldsmith DJ, Cox J, Dallyn P, Kingswood JC, Sharpstone P. An investigation of the effect of advancing uraemia, renal replacement therapy and renal transplantation on blood pressure diurnal variability. Nephrol Dial Transplant. 1997;12:2301–7.

    PubMed  Article  CAS  Google Scholar 

  36. Calzolari A, Giordano U, Matteucci M, Pastore E, Turchetta A, Rizzoni G, et al. Hypertension in young patients after renal transplantation: ambulatory blood pressure monitoring versus casual blood pressure. Am J Hypertens. 1998;11:497–501.

    PubMed  Article  CAS  Google Scholar 

  37. Sorof JM, Poffenbarger T, Portman R. Abnormal 24-hour blood pressure patterns in children after renal transplantation. Am J Kidney Dis. 2000;35:681–6.

    PubMed  Article  CAS  Google Scholar 

  38. Morgan H, Khan I, Hashmi A, Hebert D, McCrindle B, Balfe JW. Ambulatory blood pressure monitoring after renal transplantation in children. Pediatr Nephrol. 2001;16:843–7.

    PubMed  Article  CAS  Google Scholar 

  39. Mistnefes M, Portman R. Ambulatory blood pressure monitoring in pediatric renal transplantation. Pediatr Transplant. 2003;7:86–92.

    Google Scholar 

  40. Li Kam Wa TC, Macnicol AM, Watson ML. Ambulatory blood pressure in hypertensive patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant. 1997;12:2075–80.

    PubMed  Article  CAS  Google Scholar 

  41. Lama G, Tedesco MA, Graziano L, Calabrese E, Grassia C, Natale F, et al. Reflux nephropaty and hypertension: correlation with the progression of renal damage. Pediatr Nephrol. 2003;18:241–245.

    Google Scholar 

  42. Patzer L, Seeman T, Luck C, Wühl E, Janda J, Misselwitz J. Day and night time blood pressure elevation in children with higher grades of renal scarring. J Pediatr. 2003;142:117–22.

    PubMed  Article  Google Scholar 

  43. Lurbe E, Redon J, Pascual JM, Tacons J, Alvarez V. The spectrum of circadian blood pressure changes in type 1 diabetic patients. J Hypertens. 2001;19:1421–8.

    PubMed  Article  CAS  Google Scholar 

  44. Malcolm DD, Burns TL, Mahoney LT, Lauer RM. Factors affecting left ventricular mass in childhood: the Muscatine Study. Pediatrics. 1993;92:703–9.

    Google Scholar 

  45. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH. Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol. 1995;25:1056–62.

    PubMed  Article  Google Scholar 

  46. Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation. 1995;91:2400–6.

    PubMed  Article  CAS  Google Scholar 

  47. Schieken RM, Schwartz PF, Goble MM. Tracking of left ventricular mass in children: race and sex comparisons: the MCV Twin Study. Medical College of Virginia. Circulation. 1998;97:1901–6.

    PubMed  Article  CAS  Google Scholar 

  48. Sivanandam S, Sinaiko AR, Jacobs Jr DR, Steffen L, Moran A, Steinberger J. Relation of increase in adiposity to increase in left ventricular mass from childhood to young adulthood. Am J Cardiol. 2006;98:411–5.

    PubMed  Article  Google Scholar 

  49. Flynn JT, Alderman MH. Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol. 2005;20:961–6.

    PubMed  Article  Google Scholar 

  50. Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, et al. Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol. 2006;21:811–9.

    PubMed  Article  Google Scholar 

  51. Daniels SR, Loggie JM, Khoury P, Kimball TR. Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation. 1998;97:1907–11.

    PubMed  Article  CAS  Google Scholar 

  52. Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension. 2002;39:903–8.

    PubMed  Article  CAS  Google Scholar 

  53. Belsha CW, Wells TG, McNiece KL, Seib PM, Plummer JK, Berry PL. Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens. 1998;11(4 Pt 1):410–7.

    PubMed  Article  CAS  Google Scholar 

  54. Richey PA, Disessa TG, Hastings MC, Somes GW, Alpert BS, Jones DP. Ambulatory blood pressure and increased left ventricular mass in children at risk for hypertension. J Pediatr. 2008;152:343–8.

    PubMed  Article  Google Scholar 

  55. Stabouli S, Kotsis V, Rizos Z, Toumanidis S, Karagianni C, Constantopoulos A, et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol. 2009;24:1545–51.

    PubMed  Article  Google Scholar 

  56. Jourdan C, Wühl E, Litwin M, Fahr K, Trelewicz J, Jobs K, et al. Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens. 2005;23:1707–15.

    PubMed  Article  CAS  Google Scholar 

  57. Lande MB, Carson NL, Roy J, Meagher CC. Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension. 2006;48:40–4.

    PubMed  Article  CAS  Google Scholar 

  58. Stabouli S, Kotsis V, Karagianni C, Zakopoulos N, Konstantopoulos A. Blood pressure and carotid artery intima-media thickness in children and adolescents: the role of obesity. Hellenic J Cardiol. 2012;53:41–7.

    PubMed  Google Scholar 

  59. •• Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, et al. Increase in nocturnal blood pressure and progresión to microalbuminuria in Type 1 diabetes. N Engl J Med. 2002;347:797–805. The study, which involved a cohort of adolescents and young adults with type 1 diabetes, shows that an increase in blood pressure during sleep precedes the development of microalbuminuria.

    PubMed  Article  CAS  Google Scholar 

  60. •• ESCAPE Trial Group, Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361:1639–50. Intensified blood pressure control, with target 24-hour blood pressure levels in the low range of normal, confers a substantial benefit with respect to renal function among children with chronic kidney disease. Reappearance of proteinuria after initial successful pharmacologic blood pressure control is common among children who are receiving long-term ACE inhibition.

    PubMed  Article  Google Scholar 

Download references

Conflict of Interest

Empar Lurbe declares that she has no conflict of interest.

María Isabel Torró declares that she has no conflict of interest.

Julio Álvarez declares that he has no conflict of interest.

Author information

Affiliations

  1. Department of Pediatrics, Consorcio Hospital General, University of Valencia, Avda Tres Cruces 2, 46014, Valencia, Spain

    Empar Lurbe, María Isabel Torró & Julio Álvarez

  2. CIBER Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto de Salud Carlos III, Madrid, Spain

    Empar Lurbe, María Isabel Torró & Julio Álvarez

Authors
  1. Empar Lurbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. María Isabel Torró
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julio Álvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Empar Lurbe.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lurbe, E., Torró, M.I. & Álvarez, J. Ambulatory Blood Pressure Monitoring in Children and Adolescents: Coming of Age?. Curr Hypertens Rep 15, 143–149 (2013). https://doi.org/10.1007/s11906-013-0350-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-013-0350-7

Keywords

  • Hypertension
  • Blood pressure
  • BP
  • Ambulatory blood pressure monitoring
  • ABPM
  • Children
  • Adolescents
  • White coat hypertension
  • Masked hypertension
  • Organ damage