Special situations in hypertension (childhood and adolescence; pregnancy; old age)

Abstract

In infants, blood pressures are best recorded either using a mercury column and cuff with a Doppler ultrasound device to detect pulsation, or by oscillometric techniques. In older children and adolescents standard sphygmomanometry is still the cheapest and most reliable method for clinical practice, but cuff size is critical. Too small a cuff will over-estimate pressures. If possible a cuff in which the inflatable bag encircles the arm and the width is three quarters the length of the upper arm will give the most reliable readings and allow access of the stethoscope to the brachial artery. Korotkov phase V (disappearance of sounds) often does not occur in children and it is advisable to use muffling of sounds (phase IV) until after puberty. The child should be seated comfortably and quietly for several minutes and at least 3 measurements provided on any one occasion. Because of blood pressure variability it is likely that non-invasive ambulatory readings will be used increasingly to evaluate pressures in those considered at higher risk. Blood pressures recorded while children are agitated or distressed are likely to be elevated and every attempt should be made to repeat readings at a later stage. Except in severe and symptomatic cases decisions on management of those with raised pressures should only be made after readings have been repeated over a number of weeks.