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Advice from the BP Measurement Experts

Guidelines for Ambulatory Blood Pressure Monitoring in Children

Child patientHaving covered the recently rising awareness of childhood hypertension, we thought it appropriate to highlight the guidelines of using ambulatory blood pressure monitoring (ABPM) in children. The American Heart Association has published comprehensive recommendations on this topic...


 

...Which can be found here.  Additionally, separate commentary by Dr. Bruce Alpert, one of the contributing authors, can be found on the SunTech White Papers section.

In some ways, the guidelines for its use on children is not so different than for adults.  However, you should be aware of the following nuances:

  • Check the monitor’s qualification: While clinical validation to the US standard (AAMI) and to the British standard (BHS) are mandatory before a product is allowed on the market, an ABPM specifically needs to be validated for use on children and adolescents.  Make sure to inquire with the manufacturer or representative that the ABPM has been tested to and passed the validation with children as subjects.
  • Use equipment tuned for children: The ABPM should be lightweight, small, quiet, and well-protected when it is worn by the child.  More importantly, an appropriately-sized cuff must be used.
  • Use ABPM software that analyzes children’s BP readings according to the previously discussed thresholds based on age, gender, and height.

The AHA statement goes into significantly more detail.  However, the three guidelines above are the most important to successfully using ABPM on children in a medical practice.

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Ambulatory Blood Pressure Monitoring

Dr. William White interview video

An interview with Dr. William White from the 25th American Society of Hypertension Scientific Meetings

Over the course of the most recent American Society of Hypertension (ASH) Meetings held in New York City May 1 - 4th, outgoing ASH President Henry Black, MD had an opportunity to interview incoming ASH President William White MD. While their discussion covered many topics related to blood pressure monitoring, the focus was on ambulatory blood pressure monitoring (ABPM) and when and how to use it. This interview has been made available for viewing through WebMD's Medscape Cardiology page.

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2009 Medica Fair Attracts Medical Device Industry

MEDICA 2009

Highlighting the Importance of Clinical Grade Blood Pressure Technology

On the week prior to the Thanksgiving Holiday in the US, several personnel from SunTech Medical attended the 2009 MEDICA International Trade Fair in Düsseldorf, Germany. Over the four days of this event, (November 18 - 21), the world's largest medical trade fair hosted nearly 138,000 trade visitors from over 100 countries and 4,324 medical industry exhibitors from 60 different nations.

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The Importance of Ambulatory Blood Pressure Monitoring...continued

Oscar 2 ABPM in use

Part 2 of 2: What is ABPM?  Why should I get a test? ABPM Blood Pressure Guidelines.

Most hypertension opinion leaders regard ambulatory blood pressure monitoring as the gold standard for risk assessment since it is superior to both clinic and home BP measurement [4],[5]. Ambulatory blood pressure monitoring (ABPM) is a 24 hour blood pressure test in which readings are taken every 15-30 min during the day and 20-60 min during asleep hours. To learn more about ABPM, please, check out this ABPM video.


Why should I get an ambulatory blood pressure test?

ABPM provides information which home BP and clinic BP cannot including:

  1. an estimate of true, or mean, blood-pressure level
  2. diurnal rhythm of blood pressure
  3. blood pressure variability

More benefits to ABPM are summarized in the table below.

Benefits of Ambulatory Blood Pressure Monitoring over Home BP and Office BP [4]

  ABPM
Home BP
Office BP
Mean (true blood pressure)
Yes Maybe No
White-coat hypertension Yes Maybe No
Masked hypertension
Yes Maybe No
Diurnal blood pressure rhythm Yes No No
Dipping status
Yes No No
Morning surge
Yes Maybe No
Blood pressure variability
Yes Maybe No
Duration effects of BP meds
Yes Maybe No

You can see from the table above that there are several key benefits to ABPM, but you may not know why they are important. I'll highlight a few on the list.

  • White-coat hypertension: White-coat hypertension is when a patient's BP is measured high in the office because the patient might be nervous in that environment. As many as 30% of diagnosed hypertensive patients are later found to have white-coat hypertension. It is important to differentiate between white-coat and sustained hypertension, since white-coat patients do not actually need anti-hypertensive medications.
  • Night-time BP: ABPM also provides a night-time BP profile. Night-time hypertension is correlated with higher risk of cardiovascular end outcomes.
  • BP medication assessment: Finally, ABPM is especially useful for recently diagnosed hypertension or the assessment of BP meds. As mentioned earlier, the majority of Americans with hypertension do not have it under control, but they may not know that. An ABPM test can help physicians prescribe the right medications to keep blood pressure in control and reduce future cardiovascular risk. In fact, when ABPM is incorporated into the hypertension diagnostic and treatment process, up to a 14% savings in the cost of healthcare has been calculated.[6]

What are blood pressure guidelines for ABPM?

Most people are familiar with the 140/90 mmHg guidelines for blood pressure. Blood pressure guidelines for ambulatory monitoring are a little lower. The American Heart Association recommends an overall 24-hr average of 130/80 or lower. The 7th Joint National Committee states that awake ambulatory bp measurements should be below 135/85 and asleep measurements should be below 120/75. The European Society of Hypertension (ESH) states that normal awake bp is 135/85, but optimal awake 130/80. The ESH also recommends that normal asleep bp is 120/70, but optimal asleep 115/65.

If you have any questions or comments regarding your experiences with ABPM, we'd love to hear about it!

 

Back to Part 1 of "The Importance of Ambulatory Blood Pressure Monitoring"

 


 

[1] http://familydoctor.org/online/famdocen/home/common/heartdisease/treatment/770.html

[2] World Health Organization. (2003). 2003 World Health Organization (WHO)/ International Society of Hypertension (ISH) statement on the management of hypertension. Journal of Hypertension, 21, 1983-1992.

[3] American Heart Association Statistics Committee and Stroke Statistics Committee. (2009). Circulation, 119, e21 - e181.

[4] Pickering, TG, Shimbo, D, and Haas, D. (2006). Ambulatory Blood-Pressure Monitoring. New England Journal of Medicine, 354, 2368-2374.

[5] Urbina, E. et al. (2008). Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment. A Scientific Statement from the American Heart Association Arthrosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension, 52, 433-451.

[6] Krakoff, LR. (2006). Cost-Effectiveness of Ambulatory Blood Pressure. Hypertension, 47, 29-34.

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