Accuracy of Automated Blood Pressure Measurement in Children: Evidence, Issues, and Perspectives.

Abstract

There is a general consensus in the European1 and American2 guidelines for pediatric hypertension that children from 3 years of age and older who are seen in a medical setting should have their blood pressure (BP) measured. This is because hypertension in children and adolescents has become an emerging public health issue, with increasing prevalence mainly driven by the obesity epidemic in this population.1,2 Because hypertension is almost always asymptomatic until there is severe organ damage or it evolves into a malignant phase, the only method for early detection and intervention aiming to prevent its complications is the measurement of BP. The accurate measurement of BP is a prerequisite in the adults and in children for the reliable diagnosis of hypertension and the avoidance of misdiagnosis and over- or undertreatment.1,2 The main methods for noninvasive measurement of BP are the auscultatory method using conventional mercury or aneroid devices and the automated method using electronic, mostly oscillometric, devices.3 This article aims to discuss the evidence and the issues of automated BP measurement in children (age 3–12 years). Current guidelines for pediatric hypertension in Europe1 and the United States2 recommend the auscultatory BP measurement method for the diagnosis of hypertension in children. If elevated BP in children is detected by an electronic (oscillometric) BP monitor, it should be confirmed by auscultatory BP measurement.1,2 This is mainly because in children, the available reference values for defining the threshold for hypertension diagnosis have been obtained by the auscultatory method and the fact that auscultatory and automated electronic BP measurements are not necessarily interchangeable.1 In children, the auscultatory BP measurement encounters several obstacles, mainly because of anatomic and physiological characteristics of the young individuals. These include small arm dimensions, small …