The measurement of blood pressure and the detection of hypertension in children and adolescents

Despite the publication of several expert committee guidelines for the meas urement of blood pressure (BP) and the diagnosis of hypertension in childre n and adolescents, it was our perception and clinical experience that there still appeared to be a general lack of standardisation of BP measurement t echniques and little consensus on the criteria for diagnosing hypertension. To investigate this further, we have conducted a postal survey of consulta nt-grade paediatricians who were members of the British Paediatric Associat ion (BPA). A total of 1500 questionnaires were sent out and 708 analysable replies were received (47.1%). This showed that 68.6% of paediatricians rou tinely measured BP, at least on one occasion, in children or adolescents at tending their outpatient clinics, 17.7% started at or soon after birth, 12. 3% started at the age of 1 year, 20.0% at 3 years, 12.0% from 7 years of ag e and 3.5% from the age of 13. Only 60.5% reported that they had a choice o f four or more different cuff sizes in their clinic. Forty-one percent of r espondents reported that the BP was always or sometimes measured by nurses. Fifty-one percent of respondents measured diastolic BP at the phase of muf fling of sound (Korotkoff phase IV), 31.9% used the disappearance of sound (phase V) whilst 15.9% claimed that they measured both end-points. The crit eria for diagnosing a child as being hypertensive varied greatly; 17.9% rep orted that they responded to the systolic BP alone, 13.5% to the diastolic BP alone, 65.9% relied on both pressures, and 2.7% responded to either the systolic or diastolic pressure if it was raised. Furthermore, 12.9% diagnos ed hypertension if the BP exceeded the 90th percentile in relation to age a nd 41.8% used the 95th percentile. However 45.3% of respondents employed a higher dividing line. In hospitalised children, leg blood pressures were me asured routinely by 30.3%, although a further 44.0% would do so if aortic c oarctation or other vascular diseases were suspected. Despite considerable variation in clinical practice, techniques and criteria, only 11.4% of clin icians would manage the patients themselves, with the remainder referring t he child on to the appropriate specialist. The survey suggests a general la ck of standardisation of BP measurement techniques and little consensus on the criteria for diagnosing hypertension amongst paediatricians. Simplified , shortened and updated guidelines on hypertension in paediatric practice a nd research are needed.