Impact of ambulatory blood pressure monitoring on the management of hypertension in children

Background Ambulatory blood pressure monitoring (ABPM) is widely utilized f or the evaluation and management of hypertension in adults but has not been routinely used in the care of hypertensive children. Design To examine the potential impact that the routine use of ABPM might h ave on the evaluation and management of hypertension in children, we review ed our early experience with this technique, comparing management decisions based on ABPM with those based on casual blood pressure readings. Methods Twenty children (4 - 17 years old) underwent ABPM for either the in itial evaluation of suspected hypertension or the ongoing management of kno wn hypertension. ABPM studies were considered abnormal if over 40% of both systolic and/or diastolic blood pressure readings were above the 95th perce ntile for the child's age and gender. Results Of 13 children studied for su spected hypertension, nine had abnormal ABPM studies and were treated, but four had normal results and were therefore not treated. Of seven children w ith known hypertension studied by ABPM to assess their blood pressure contr ol further, three had normal results and no management changes were made, b ut four had abnormal studies, prompting a change in therapy or further diag nostic testing. Overall, eight out of 20 ABPM studies led to the initiation of further diagnostic evaluation or a change in planned or ongoing therapy . Conclusions We conclude that ABPM has the potential to become an important tool in the evaluation and management of childhood hypertension, and sugges t that more widespread use of this technique in children is appropriate. (C ) 2000 Lippincott Williams & Wilkins.