Abstract
Purpose of Review
This is a review of ambulatory blood pressure monitoring (ABPM) use in pediatrics, summarizing current knowledge and uses of ABPM.
Recent Findings
Updated guidelines from the American Academy of Pediatrics have emphasized the value of ABPM. ABPM is necessary to diagnose white coat hypertension, masked hypertension, and nocturnal hypertension associated with specific conditions. There is growing evidence that ABPM may be useful in these populations. ABPM has been demonstrated to be more predictive of end-organ damage in pediatric hypertension compared to office blood pressure.
Summary
ABPM is an important tool in the diagnosis and management of pediatric hypertension. Routine use of ABPM could potentially prevent early cardiovascular morbidity and mortality in a wide variety of populations.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Chaudhuri A. Pediatric ambulatory blood pressure monitoring: diagnosis of hypertension. Pediatr Nephrol. 2013;28(7):995–9. https://doi.org/10.1007/s00467-013-2470-3.
Veiga EV, Arcuri EA, Cloutier L, Santos JL. Blood pressure measurement: arm circumference and cuff size availability. Rev Lat Am Enfermagem. 2009;17(4):455–61. https://doi.org/10.1590/s0104-11692009000400004.
Zaheer S, Watson L, Webb NJ. Unmet needs in the measurement of blood pressure in primary care. Arch Dis Child. 2014;99(5):463–4. https://doi.org/10.1136/archdischild-2013-305277.
Burke MJ, Towers HM, O'Malley K, Fitzgerald DJ, O'Brien ET. Sphygmomanometers in hospital and family practice: problems and recommendations. Br Med J (Clin Res Ed). 1982;285(6340):469–71. https://doi.org/10.1136/bmj.285.6340.469.
Thomas M, Radford T, Dasgupta I. Unvalidated blood pressure devices with small cuffs are being used in hospitals. BMJ. 2001;323(7309):398.
Savoca MR, MacKey ML, Evans CD, Wilson M, Ludwig DA, Harshfield GA. Association of ambulatory blood pressure and dietary caffeine in adolescents. Am J Hypertens. 2005;18(1):116–20. https://doi.org/10.1016/j.amjhyper.2004.08.011.
Flynn JT, Urbina EM. Pediatric ambulatory blood pressure monitoring: indications and interpretations. J Clin Hypertens (Greenwich). 2012;14(6):372–82. https://doi.org/10.1111/j.1751-7176.2012.00655.x.
Feber J, Litwin M. Blood pressure (BP) assessment-from BP level to BP variability. Pediatr Nephrol. 2016;31(7):1071–9. https://doi.org/10.1007/s00467-015-3161-z.
• Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3). doi:https://doi.org/10.1542/peds.2017-1904. Updated guidelines for pediatric hypertension from the American Academy of Pediatrics. An emphasis was placed on ABPM for evaluation and management of hypertension in children and adolescents.
McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150(6):640–4, 4.e1. https://doi.org/10.1016/j.jpeds.2007.01.052.
Samuel JP, Bell CS, Hebert SA, Varughese A, Samuels JA, Tyson JE. Office blood pressure measurement alone often misclassifies treatment status in children with primary hypertension. Blood Press Monit. 2017;22(6):328–32. https://doi.org/10.1097/mbp.0000000000000299.
Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63(5):1116–35. https://doi.org/10.1161/hyp.0000000000000007.
• 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(3):433–51. https://doi.org/10.1161/hypertensionaha.108.190329 Contains detailed instructions on performing ABPM in children and adolescents.
The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl):555–76.
Sinha MD, Booth CJ, Reid CJ. Factors affecting success of blood pressure measurements during ambulatory blood pressure monitoring in children with renal disease. Cardiol Young. 2011;21(3):310–6. https://doi.org/10.1017/s1047951110002003.
Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens. 2002;20(10):1995–2007.
Andrade H, Pires A, Noronha N, Amaral ME, Lopes L, Martins P, et al. Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension. Rev Port Cardiol. 2018;37(9):783–9. https://doi.org/10.1016/j.repc.2017.09.026.
Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens. 2004;22(2):273–80.
Hansen TW, Li Y, Boggia J, Thijs L, Richart T, Staessen JA. Predictive role of the nighttime blood pressure. Hypertension. 2011;57(1):3–10. https://doi.org/10.1161/hypertensionaha.109.133900.
Cuspidi C, Sala C, Tadic M, Gherbesi E, De Giorgi A, Grassi G, et al. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: an updated review. J Clin Hypertens (Greenwich). 2017;19(7):713–21. https://doi.org/10.1111/jch.13023.
• Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The association of pediatric obesity with nocturnal non-dipping on 24-hour ambulatory blood pressure monitoring. Am J Hypertens. 2016;29(5):647–52. https://doi.org/10.1093/ajh/hpv147 Retrospective study of 247 obese and 161 lean children. Obese children were more likely to be non-dipping. No association was noted between non-dipping and left ventricular hypertrophy.
Krzych LJ, Szydlowski L. Determinants of inappropriate circadian blood pressure variability in children with essential hypertension. Can J Cardiol. 2009;25(1):e13–6. https://doi.org/10.1016/s0828-282x(09)70024-8.
Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348(24):2407–15. https://doi.org/10.1056/NEJMoa022273.
Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994;24(6):793–801.
Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156–61. https://doi.org/10.1161/01.HYP.0000170138.56903.7a.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561–6. https://doi.org/10.1056/nejm199005313222203.
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(19):1907–11.
Hanevold C, Waller J, Daniels S, Portman R, Sorof J. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics. 2004;113(2):328–33.
Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension. 2002;39(4):903–8.
Maggio AB, Aggoun Y, Marchand LM, Martin XE, Herrmann F, Beghetti M, et al. Associations among obesity, blood pressure, and left ventricular mass. J Pediatr. 2008;152(4):489–93. https://doi.org/10.1016/j.jpeds.2007.10.042.
O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340(1):14–22. https://doi.org/10.1056/nejm199901073400103.
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(6):811–9. https://doi.org/10.1007/s00467-006-0068-8.
Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr. 2005;147(5):651–6. https://doi.org/10.1016/j.jpeds.2005.06.008.
Al-Shorman A, Al-Domi H, Al-Atoum M. The associations of body composition and anthropometric measures with carotid intima-media thickness in obese and non-obese schoolchildren: a possible predictor for cardiovascular diseases. Vascular. 2018;26(3):285–90. https://doi.org/10.1177/1708538117735457.
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(1):40–4. https://doi.org/10.1161/01.HYP.0000227029.10536.e8.
Georgakis MK, Synetos A, Mihas C, Karalexi MA, Tousoulis D, Seshadri S, et al. Left ventricular hypertrophy in association with cognitive impairment: a systematic review and meta-analysis. Hypertens Res. 2017;40(7):696–709. https://doi.org/10.1038/hr.2017.11.
Peterson CG, Miyashita Y. The use of ambulatory blood pressure monitoring as standard of care in pediatrics. Front Pediatr. 2017;5:153. https://doi.org/10.3389/fped.2017.00153.
Lande MB, Kaczorowski JM, Auinger P, Schwartz GJ, Weitzman M. Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States. J Pediatr. 2003;143(6):720–4. https://doi.org/10.1067/s0022-3476(03)00412-8.
Lande MB, Batisky DL, Kupferman JC, Samuels J, Hooper SR, Falkner B, et al. Neurocognitive function in children with primary hypertension. J Pediatr. 2017;180:148–55.e1. https://doi.org/10.1016/j.jpeds.2016.08.076.
• Kupferman JC, Batisky DL, Samuels J, Adams HR, Hooper SR, Wang H, et al. Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension. Pediatr Nephrol. 2018;33(10):1765–71. https://doi.org/10.1007/s00467-018-3954-y A study of 75 children with untreated primary hypertension matched to 75 normotensive controls. ABPM was superior to office BP in identification of lower neurocognitive test performance.
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(8):1151–5. https://doi.org/10.1007/s00467-005-1979-5.
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(9 Pt 1):855–60. https://doi.org/10.1016/s0895-7061(01)02180-x.
Cohen JB, Lotito MJ, Trivedi UK, Denker MG, Cohen DL, Townsend RR. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis. Ann Intern Med. 2019. https://doi.org/10.7326/m19-0223.
Franklin SS, Thijs L, Hansen TW, O'Brien E, Staessen JA. White-coat hypertension: new insights from recent studies. Hypertension. 2013;62(6):982–7. https://doi.org/10.1161/hypertensionaha.113.01275.
Mancia G, Facchetti R, Grassi G, Bombelli M. Adverse prognostic value of persistent office blood pressure elevation in white coat hypertension. Hypertension. 2015;66(2):437–44. https://doi.org/10.1161/hypertensionaha.115.05367.
Siven SS, Niiranen TJ, Kantola IM, Jula AM. White-coat and masked hypertension as risk factors for progression to sustained hypertension: the Finn-Home study. J Hypertens. 2016;34(1):54–60. https://doi.org/10.1097/hjh.0000000000000750.
Kavey RE, Kveselis DA, Atallah N, Smith FC. White coat hypertension in childhood: evidence for end-organ effect. J Pediatr. 2007;150(5):491–7. https://doi.org/10.1016/j.jpeds.2007.01.033.
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(2):392–5. https://doi.org/10.1161/hypertensionaha.107.092197.
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(1):50–4. https://doi.org/10.1016/j.jpeds.2008.01.025.
Gupta-Malhotra M, Hamzeh RK, Poffenbarger T, McNiece-Redwine K, Hashmi SS. Myocardial performance index in childhood onset essential hypertension and white coat hypertension. Am J Hypertens. 2016;29(3):379–87. https://doi.org/10.1093/ajh/hpv123.
Pall D, Juhasz M, Lengyel S, Molnar C, Paragh G, Fulesdi B, et al. Assessment of target-organ damage in adolescent white-coat and sustained hypertensives. J Hypertens. 2010;28(10):2139–44. https://doi.org/10.1097/HJH.0b013e32833cd2da.
Litwin M, Niemirska A, Ruzicka M, Feber J. White coat hypertension in children: not rare and not benign? J Am Soc Hypertens. 2009;3(6):416–23. https://doi.org/10.1016/j.jash.2009.10.002.
Miyashita Y, Flynn JT, Hanevold CD. Diagnosis and management of white-coat hypertension in children and adolescents: a Midwest Pediatric Nephrology Consortium study. J Clin Hypertens (Greenwich). 2017;19(9):884–9. https://doi.org/10.1111/jch.13006.
Iturzaeta A, Pompozzi L, Casas Rey C, Passarelli I, Torres F. Prevalence of masked hypertension among children with risk factors for arterial hypertension. Arch Argent Pediatr. 2018;116(5):328–32. https://doi.org/10.5546/aap.2018.eng.328.
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(4):493–8. https://doi.org/10.1161/01.HYP.0000160320.39303.ab.
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(1):137–44. https://doi.org/10.1681/asn.2009060609.
Matsuoka S, Awazu M. Masked hypertension in children and young adults. Pediatr Nephrol. 2004;19(6):651–4. https://doi.org/10.1007/s00467-004-1459-3.
Luo XX, Zhu Y, Sun Y, Ge Q, Su J, So HK, et al. Does masked hypertension cause early left ventricular impairment in youth? Front Pediatr. 2018;6:167. https://doi.org/10.3389/fped.2018.00167.
So HK, Yip GW, Choi KC, Li AM, Leung LC, Wong SN, et al. Association between waist circumference and childhood-masked hypertension: a community-based study. J Paediatr Child Health. 2016;52(4):385–90. https://doi.org/10.1111/jpc.13121.
Samuels J, Ng D, Flynn JT, Mitsnefes M, Poffenbarger T, Warady BA, et al. Ambulatory blood pressure patterns in children with chronic kidney disease. Hypertension. 2012;60(1):43–50. https://doi.org/10.1161/hypertensionaha.111.189266.
Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361(17):1639–50. https://doi.org/10.1056/NEJMoa0902066.
Vidi SR. Role of hypertension in progression of chronic kidney disease in children. Curr Opin Pediatr. 2018;30(2):247–51. https://doi.org/10.1097/mop.0000000000000595.
Seeman T, Simkova E, Kreisinger J, Vondrak K, Dusek J, Gilik J, et al. Improved control of hypertension in children after renal transplantation: results of a two-yr interventional trial. Pediatr Transplant. 2007;11(5):491–7. https://doi.org/10.1111/j.1399-3046.2006.00661.x.
Seeman T, Vondrak K, Dusek J. Effects of the strict control of blood pressure in pediatric renal transplant recipients-ESCORT trial. Pediatr Transplant. 2019;23(1):e13329. https://doi.org/10.1111/petr.13329.
McLin VA, Anand R, Daniels SR, Yin W, Alonso EM. Blood pressure elevation in long-term survivors of pediatric liver transplantation. Am J Transplant. 2012;12(1):183–90. https://doi.org/10.1111/j.1600-6143.2011.03772.x.
Abu-Elmagd KM, Kosmach-Park B, Costa G, Zenati M, Martin L, Koritsky DA, et al. Long-term survival, nutritional autonomy, and quality of life after intestinal and multivisceral transplantation. Ann Surg. 2012;256(3):494–508. https://doi.org/10.1097/SLA.0b013e318265f310.
Tainio J, Qvist E, Miettinen J, Holtta T, Pakarinen M, Jahnukainen T, et al. Blood pressure profiles 5 to 10 years after transplant in pediatric solid organ recipients. J Clin Hypertens (Greenwich). 2015;17(2):154–61. https://doi.org/10.1111/jch.12465.
Hryniewiecka E, Pilecki T, Zieniewicz K, Paczek L. Circadian and short-term blood pressure abnormalities after liver transplantation. Clin Exp Hypertens. 2018;40(8):730–3. https://doi.org/10.1080/10641963.2018.1431248.
Del Compare ME, D'Agostino D, Ferraris JR, Boldrini G, Waisman G, Krmar RT. Twenty-four-hour ambulatory blood pressure profiles in liver transplant recipients. Pediatr Transplant. 2004;8(5):496–501. https://doi.org/10.1111/j.1399-3046.2004.00192.x.
O'Sullivan JJ, Derrick G, Gray J. Blood pressure after cardiac transplantation in childhood. J Heart Lung Transplant. 2005;24(7):891–5. https://doi.org/10.1016/j.healun.2004.05.025.
Gupta-Malhotra M, Banker A, Shete S, Hashmi SS, Tyson JE, Barratt MS, et al. Essential hypertension vs. secondary hypertension among children. Am J Hypertens. 2015;28(1):73–80. https://doi.org/10.1093/ajh/hpu083.
Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, et al. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol. 2013;62(11):1020–5. https://doi.org/10.1016/j.jacc.2013.06.016.
Tong F, Li ZQ, Li L, Chong M, Zhu YB, Su JW, et al. The follow-up surgical results of coarctation of the aorta procedures in a cohort of Chinese children from a single institution. Heart Lung Circ. 2014;23(4):339–46. https://doi.org/10.1016/j.hlc.2013.10.060.
Padang R, Dennis M, Semsarian C, Bannon PG, Tanous DJ, Celermajer DS, et al. Detection of serious complications by MR imaging in asymptomatic young adults with repaired coarctation of the aorta. Heart Lung Circ. 2014;23(4):332–8. https://doi.org/10.1016/j.hlc.2013.10.055.
Lee MG, Allen SL, Kawasaki R, Kotevski A, Koleff J, Kowalski R, et al. High prevalence of hypertension and end-organ damage late after coarctation repair in normal arches. Ann Thorac Surg. 2015;100(2):647–53. https://doi.org/10.1016/j.athoracsur.2015.03.099.
Macumber I. Ambulatory blood pressure monitoring in children and adolescents: a review of recent literature and new guidelines. Curr Hypertens Rep. 2017;19(12):96. https://doi.org/10.1007/s11906-017-0791-5.
Downie ML, Ulrich EH, Noone DG. An update on hypertension in children with type 1 diabetes. Can J Diabetes. 2018;42(2):199–204. https://doi.org/10.1016/j.jcjd.2018.02.008.
Kir M, Cetin B, Demir K, Yilmaz N, Kizilca O, Demircan T, et al. Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings. Pediatr Diabetes. 2016;17(1):21–7. https://doi.org/10.1111/pedi.12234.
Lee SH, Kim JH, Kang MJ, Lee YA, Won Yang S, Shin CH. Implications of nocturnal hypertension in children and adolescents with type 1 diabetes. Diabetes Care. 2011;34(10):2180–5. https://doi.org/10.2337/dc11-0830.
Dost A, Bechtold-Dalla Pozza S, Bollow E, Kovacic R, Vogel P, Feldhahn L, et al. Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: impact on diabetic complications. Pediatr Diabetes. 2017;18(8):874–82. https://doi.org/10.1111/pedi.12502.
Shikha D, Singla M, Walia R, Potter N, Umpaichitra V, Mercado A, et al. Ambulatory blood pressure monitoring in lean, obese and diabetic children and adolescents. Cardiorenal Med. 2015;5(3):183–90. https://doi.org/10.1159/000381629.
Dart AB, Wicklow BA, Sellers EA, Dean HJ, Malik S, Walker J, et al. The improving renal complications in adolescents with type 2 diabetes through the REsearch (iCARE) Cohort Study: rationale and protocol. Can J Diabetes. 2014;38(5):349–55. https://doi.org/10.1016/j.jcjd.2014.07.224.
Dart AB, Wicklow B, Blydt-Hansen TD, Sellers EAC, Malik S, Chateau D, et al. A holistic approach to risk for early kidney injury in indigenous youth with type 2 diabetes: a proof of concept paper from the iCARE cohort. Can J Kidney Health Dis. 2019;6:2054358119838836. https://doi.org/10.1177/2054358119838836.
Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Analysis of 24-hour ambulatory blood pressure monitoring in children with obstructive sleep apnea: a hospital-based study. Medicine (Baltimore). 2015;94(40):e1568. https://doi.org/10.1097/md.0000000000001568.
Madaeva I, Berdina O, Polyakov V, Kolesnikov S. Obstructive sleep apnea and hypertension in adolescents: effect on neurobehavioral and cognitive functioning. Can Respir J. 2016;2016:3950914–6. https://doi.org/10.1155/2016/3950914.
Amin R, Somers VK, McConnell K, Willging P, Myer C, Sherman M, et al. Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing. Hypertension. 2008;51(1):84–91. https://doi.org/10.1161/hypertensionaha.107.099762.
Ng DK, Wong JC, Chan CH, Leung LC, Leung SY. Ambulatory blood pressure before and after adenotonsillectomy in children with obstructive sleep apnea. Sleep Med. 2010;11(7):721–5. https://doi.org/10.1016/j.sleep.2009.10.007.
Hsu WC, Kang KT, Chiu SN, Weng WC, Lee PL, Lin CY. 24-Hour ambulatory blood pressure after adenotonsillectomy in childhood sleep apnea. J Pediatr. 2018;199:112–7.e6. https://doi.org/10.1016/j.jpeds.2018.03.072.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Implementation to Increase Blood Pressure Control: What Works?
Rights and permissions
About this article
Cite this article
Patel, S.S., Daniels, S.R. Ambulatory Blood Pressure Monitoring in Pediatrics. Curr Hypertens Rep 21, 71 (2019). https://doi.org/10.1007/s11906-019-0976-1
Published:
DOI: https://doi.org/10.1007/s11906-019-0976-1