Measurement of blood pressure at home: survey among pediatric nephrologists

Abstract.

Recently, an international consensus paper was published for standardization of home self-blood pressure (BP) measurement in adults. However, few data exist regarding home BP measurement in children, although it is recommended for all pediatric patients on renal replacement therapy in Germany. Therefore, a survey was performed among German-speaking pediatric nephrologists (members of the Arbeitsgemeinschaft Pädiatrische Nephrologie) in order to study their opinions about home blood pressure measurements. Approximately 75% of German pediatric nephrology centers responded to the survey. More than 70% of the interviewees prescribed a blood pressure device for all children with renal diseases and hypertension or on renal replacement therapy. For children with antihypertensive medication, 2.8 daily measurements were recommended at mean and 2.2 measurements for children without therapy. Auscultation of Korotkoff sounds and oscillometric BP measurements were used in the same percentage for home BP recordings. The upper cut of level for home blood pressure values was rated by the pediatric nephrologists and compared to reference values of casual blood pressure. There was good agreement for upper systolic BP, but as many as 40 to 50% of the interviewees accepted upper diastolic BP values higher than the 97th percentile for casual BP. Home BP measurement was judged to be more important than office BP measurement by 64% of the nephrologists and less important than 24 h ambulatory blood pressure monitoring by 67%. The results of the survey showed wide discrepancies for standards of home BP measurement in children and adolescents, especially for the recommendations for upper diastolic BP. Before home blood pressure measurements can be recommended unrestrictedly in children and adolescents, we stress the need for standardization of blood pressure devices and measurement. Prospective studies in children are needed to demonstrate that these standards facilitate better prediction of cardiovascular outcome using home BP measurements compared to office BP recordings in children.