Cincinnati, OH - The American Heart Association (AHA) is recommending ambulatory blood pressure monitoring (ABPM) for certain children and adolescents suspected of having high blood pressure. In a scientific statement published online August 4, 2008 in Hypertension [1], Dr Elaine Urbina (Cincinnati Children's Hospital Medical Center, OH) and colleagues say that accurate diagnosis and early treatment of clinical hypertension is essential in this age group and that ABPM can aid in such diagnoses.

Senior author Dr Stephen Daniels (The Children's Hospital, Aurora, CO) told heartwire: "This is written for pediatricians, pediatric cardiologists, and others who take care of children with hypertension. It's meant to be an up-to-date compilation of the literature around ABPM, providing a blueprint for how ABPM should be used for the evaluation of such children.

"One of the big questions in pediatrics is whether high blood pressure is a white-coat phenomenon or not, and ABPM is one of the important ways in which we can get a better understanding of this," he added. Although there have been numerous papers about ABPM and some guidelines for its use in adults, "there hasn't been as much of a focus on pediatric monitoring, and that is what we wanted to address."

There hasn't been as much of a focus on pediatric monitoring, and that is what we wanted to address.

In ABPM, the patient wears a blood-pressure cuff attached to a portable data recorder during daily activities and sleep. At least once each hour the cuff inflates and the device records a reading throughout a 24-hour period.

"There is now sufficient experience with ABPM to recommend its use in pediatric patients to assist in diagnosing hypertension," Urbina says in an AHA press release.

The statement includes recommendations for doctors on choosing an ABPM machine and caring for the equipment, as well as guidelines on fitting cuffs to pediatric patients.

While the AHA recently recommended home monitoring for adults with high blood pressure, the authors of the statement say ABPM has better diagnostic specificity for children compared with home measurement. But because the use of ABPM in children is relatively new, there are little data on the technology's predictive ability or its effects on hard outcomes such as heart attack and stroke, so the statement is expert-opinion driven rather than evidence-based, they note.

"It is clear that ABPM is useful in the evaluation of BP levels in youth. However, there is a need for larger data sets . . . [and] additional data will also be important in evaluating the efficacy of ABPM in measuring effects of interventions and reversal of target organ damage," they write.

Many people, before taking the plunge to use medication, would consider an ABPM test to get a better handle on whether the clinic BP is a true reflection of the BP.

The writing committee recommends using ABPM to rule out white-coat hypertension and masked hypertension (normal levels at the clinic but high blood pressure at home). It can also be useful for evaluating the effectiveness of high blood-pressure medications, observing whether blood pressure decreases at night during sleep, and evaluating apparent drug-resistant hypertension, they note.

"These guidelines help pediatric healthcare providers to understand the use of ABPM in monitoring children's blood pressure," says Urbina. "Ambulatory monitoring is likely to be most useful in children whose office blood pressure readings are up to 10% over the highest acceptable reading, as children with very high readings (more than 10% higher than the highest reading) are more likely to have true high blood pressure," she notes.

Daniels said ABPM can be particularly useful in deciding who should get antihypertensive medications. "A common scenario is that you get BPs in the clinic that you are worried about, and you may have tried some nonpharmacologic interventions with diet and physical activity, for example. But you are left with a BP that is still higher that you'd like. Many people, before taking the plunge to use medication, would consider an ABPM test to get a better handle on whether the clinic BP is a true reflection of the BP."