Twenty-four hour ambulatory blood pressure monitoring: Pediatricians still lagging behind

by Bruce Alpert, MD

Twenty-four hour ambulatory blood pressure monitoring (ABPM) has become a routine procedure in adult medicine over recent years. It provides physicians with the best estimate of true blood pressure and blood pressure variability. In the February 1997 issue of the Journal of Pediatrics, I wrote an editorial with Stephen Daniels, M.D., Ph.D., expressing the opinion that pediatricians needed to “catch-up” with adult physicians in their awareness of the uses and benefits of 24-hour ABPM.¹ In that same issue, the largest series of children undergoing ABPM research to date, including 1141 adolescents was published by Soergel et al.² This article presented guidelines for classifying normal and elevated systolic and diastolic BP levels during awake, asleep, and 24- hour time periods for children and adolescents. With these published guidelines, it was our hope that ABPM would become the standard of care for identifying and managing hypertension in pediatric patients. Unfortunately, eleven years after my original editorial, ABPM is still widely under-utilized by the pediatric healthcare community.