Multiple office blood pressure monitoring for the diagnosis of hypertension in children.

IF 2.6 3区医学 Q1 PEDIATRICS European Journal of Pediatrics Pub Date : 2025-02-27 DOI:10.1007/s00431-025-06040-9

Letizia Dato, Maria Cristina Mancuso, Thomas Ria, Laura Viola, Patrizia Salice, Matteo Vidali, Daniele Rossetti, Giacomo Tamburini, Teresa Nittoli, Chiara Tamburello, Teodora Munteanu, Chiara Orsenigo, Loredana Simionato, Andrea Gualtieri, Elena Sacchini, Gianluigi Ardissino

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Abstract

The measurement (M) of blood pressure (BP) in children may be challenging, and the ideal approach, free of critical issues (such as the interference due to the white coat effect or to the high variability), has yet to be identified. Herein, we compare BP as measured with multiple office BP monitoring (mOBPM) with the standard approach as suggested by guidelines. A cohort of healthy children underwent two mOBPMs 1 year apart. Mean systolic and diastolic values obtained by mOBPM were compared with the 1st, 2nd, 3rd, and 4th measurements (repeated measures ANOVA). mOBPMs with a coefficient of variation (CV) > 15% were excluded. The number of children with BP > 90th centile was determined based on (a) each of the initial three readings, (b) the mean of the 2nd and 3rd Ms, (c) the 4th M, (d) the mOBPM at baseline, and (e) 1 year apart. Out of 164 enrolled children, 13 (7.9%) were excluded because of a CV > 15%. The analysis on the remaining 151 children showed that the first three Ms provided a significantly higher BP than the mOBPM. The 4th M was the first one to be aligned with the results of the mOBPM. Based on the 1st, 2nd, 3rd, and 4th Ms, a BP > 90th centile was observed in 29, 20, 21, and 16 children, respectively. The mean of the 2nd and 3rd Ms identified 12 children with high BP, while the mOBPM revealed elevated BP in only 6 children and this finding was confirmed only in 3 of them 1 year later.

Conclusion: The first three readings systematically overestimate BP, while the 4th one better aligns with the mOBPM. If the 4th reading is abnormal, the complete mOBPM will likely offer a more reliable BP assessment.

What is known: • Blood pressure measurement may be challanging and initial readings systematically overestimate real values.

What is new: • The 4th blood pressure reading better aligns with the mean of 10 measurements. In daily clinical practice, if the 4th reading is abnormal, the complete mOBPM (www.mobpm.com) will likely offer a more reliable BP assessment.

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多室血压监测对儿童高血压的诊断价值。

儿童血压（BP）的测量(M)可能具有挑战性，理想的方法，没有关键问题（如由于白大衣效应或高变异性的干扰），尚未确定。在此，我们比较了多重办公室血压监测（mOBPM）测量的血压与指南建议的标准方法。一组健康儿童间隔1年接受两次mobpm。将mOBPM获得的平均收缩压和舒张压值与第1、2、3和4次测量结果进行比较（重复测量方差分析）。排除变异系数（CV）为0 ~ 15%的mobpm。根据(a)最初三个读数中的每一个，(b)第2和第3个M的平均值，(c)第4个M， (d)基线时的mOBPM， (e)间隔1年确定血压达到90百分位的儿童人数。在164名入组儿童中，13名（7.9%）因CV bb（15%）而被排除。对其余151名儿童的分析表明，前3个Ms的血压明显高于mOBPM。第四次选举是第一次与mOBPM的结果一致。根据第1、2、3、4 Ms，分别在29、20、21、16例患儿中观察到90百分位血压增高。第2次和第3次Ms的平均值确定了12名血压升高的儿童，而mOBPM显示只有6名儿童血压升高，这一发现在1年后仅在其中3名儿童中得到证实。结论：前3次读数系统地高估了血压，而第4次读数更符合mOBPM。如果第4个读数异常，完整的mOBPM可能会提供更可靠的血压评估。•血压测量可能具有挑战性，初始读数系统地高估了实际值。创新之处在于：•第4次血压读数与10次测量的平均值更加一致。在日常临床实践中，如果第4次读数异常，完整的mOBPM （www.mobpm.com）可能会提供更可靠的血压评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.