Blood Pressure Monitoring In Children Research Articles

Fifteen Years of Experience in Ambulatory Blood Pressure Monitoring in Children at a Single Center

Fifteen Years of Experience in Ambulatory Blood Pressure Monitoring in Children at a Single Center

Update on Ambulatory Blood Pressure Monitoring in Children

Update on Ambulatory Blood Pressure Monitoring in Children

Ambulatory blood pressure monitoring in children and adolescents post-hematopoietic stem cell transplantation.

One of the long-term complications after hematopoietic stem cell transplantation (HSCT) is hypertension (HT). Previous studies showed that 10-15% of children post-HSCT had office HT, but onlya few studies used ambulatory blood pressure monitoring (ABPM). The present study was aimed at exploring the frequency and factors associated with ABPM HT in children post-HSCT. Patients aged ≥ 6years who survived ≥ 2years after HSCT were enrolled. Clinical and ABPM data were reviewed. ABPM HT was defined according to the 2022 American Heart Association guidelines. Factors associated with HT were analyzed by logistic regression. Ninety-eight (60 males) patients with a mean age of 15.1years and a median follow-up time at 4.5years after HSCT were included. Fifteen patients (15.3%) had ABPM HT (2 ambulatory HT and 13 masked HT). The ABPM HT group had a significantly older age (19 vs. 14years), a higher proportion of males (87% vs. 57%), a higher office systolic BP index (0.93 vs. 0.85), a higher office diastolic BP index (0.96 vs. 0.82) and a higher proportion of current use of prednisolone and tacrolimus than those in the normal ABPM group. Multivariate analysis revealed that office diastolic BP index was associated with ABPM HT. Left ventricular mass index was significantly correlated with ABPM but not with office BP parameters. HT in children post-HSCT was not uncommon and most could not be detected with office BP measurement. A diastolic BP index can be used as a screening tool for HT. A higher resolution version of the Graphical abstract is available as Supplementary information.

Ambulatory blood pressure monitoring in children: A retrospective single-center study.

(1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO). Single-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP. With the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R 2 = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not. In our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertrophy.

Evaluation of renal function and ambulatory blood pressure monitoring in children and adolescents: The role of birthweight

Objective: A marked relationship is known between low birth weight and reduced nephron number. In this study, it was aimed to investigate the effects of low birth weight on renal function and blood pressure in healthy children and adolescents. Methods: This study was carried out on 33 children (7 to 18 years) who were born with a birth weight under 2500 g. The control group was composed of 30 children born at term with a birth weight appropriate for gestational age. Urine microalbumin, N-Acetyl-β-D Glucosaminidase, sodium levels and blood urea nitrogen, creatinine, and cystatin-C levels were investigated in patients and the control group. The sizes of kidneys in both groups were examined by ultrasonography. Blood pressure was monitored for 24 hours as ambulatory blood pressure. Results: The study group had higher levels of blood cystatin-C, urinary sodium, and N-Acetyl-βD-Glucosaminidase than the control group. Kidney volumes were smaller in the study group than in the controls. Conclusion: In our study, we observed that some glomerular and tubular functions were affected in children with low birth weight and in children born preterm. These effects were not observed in children with mature small for gestational age. Considering that nephron formation is completed at the 37th week, gestational age (prematurity) was thought to affect glomerular maturation more than intrauterine growth retardation. Our findings did not demonstrate hypertension in children born with low birth weight in childhood. We suggest that low birth weight children should be followed carefully for renal functions and blood pressure.

Nocturnal Hypertension in Children With Chronic Kidney Disease Is Common and Associated With Progression to Kidney Replacement Therapy.

Nocturnal hypertension is a risk factor for chronic kidney disease (CKD) progression among adults. In children, effects of nocturnal hypertension on CKD progression is less studied. We investigated the relationships between nocturnal, daytime, or sustained hypertension and progression to kidney replacement therapy in children using Cox proportional hazards models. Nocturnal and diurnal hypertension respectively defined as: mean blood pressure >95th percentile and/or load >25% for either systolic or diastolic blood pressure within sleep or wake periods. One thousand five hundred seventy-seven ambulatory blood pressure monitoring studies from 701 CKiD participants were reviewed. Nighttime, daytime, and both types of hypertension were 19%, 7%, and 33%, respectively. Participants with both daytime and nocturnal hypertension had the highest risk of kidney replacement therapy. Among children with CKD, compared with those who were normotensive, those with isolated nocturnal hypertension had a hazard ratio of 1.49 ([CI, 0.97-2.28]; P=0.068) while those with both daytime and nocturnal hypertension had a HR of 2.23 ([CI, 1.60-3.11]; P<0.001) when adjusted for age, race, sex, and baseline proteinuria and glomerular filtration. Estimates for risk were similar among glomerular and nonglomerular participants but not significant in glomerular due to smaller sample size. The presence of both daytime and nocturnal hypertension is significantly associated with risk of kidney replacement therapy. Our study confirms the utility of ambulatory blood pressure monitoring in children with CKD. Identifying and controlling both daytime and nocturnal hypertension using ambulatory blood pressure monitoring may improve outcomes and delay CKD progression in this population.

Ambulatory blood pressure monitoring in children and adolescents

Ambulatory blood pressure monitoring in children and adolescents

Racial-ethnic diversity in ambulatory blood pressure monitoring in children with chronic kidney disease

BackgroundBlack adults with chronic kidney disease (CKD) have higher rates of hypertension as compared to White adults with CKD. Little is known of how race and ethnicity associate with the prevalence of hypertension in pediatric CKD patients. The aim was to compare ambulatory blood pressure monitoring (ABPM) results for patients with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study across racial-ethnic groups.MethodsPatients from the CKiD study who identified as non-Hispanic White, non-Hispanic Black, or Hispanic were included to analyze differences in ABPM results across these racial-ethnic groups. The outcomes were fitted using 3 progressively adjusted models.ResultsThis study included 501 CKiD participants with at least one successful ABPM study. Compared to White participants, Black participants had 4.2 mmHg higher mean sleep systolic blood pressure and 2.7 mmHg higher mean sleep diastolic blood pressure (p = 0.001 and p = 0.004, respectively). Additionally, Black participants had higher odds of abnormal wake systolic load (OR 1.88, 1.21–2.91, p = 0.005), wake diastolic load (OR 1.68, 1.03–2.73, p = 0.04), sleep systolic load (OR 2.19, 1.36–3.5, p = 0.001), sleep diastolic load (OR 2.01, 1.28–3.15, p = 0.002), systolic non-dipping (OR 2.02, 1.31–3.10, p = 0.001), and diastolic non-dipping (OR 2.69, 1.60–4.51, p < 0.001). Compared to White participants, Hispanic participants demonstrated only a lower sleep diastolic load (OR 0.54, 0.31–0.95, p = 0.03).ConclusionsBlack children with CKD have higher absolute nocturnal blood pressures and higher rates of abnormal dipping. Further studies are needed to determine the etiology of these differences and the clinical implications of racial-ethnic differences in ABPM outcomes within the pediatric CKD population.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Ambulatory Blood Pressure Monitoring in Children with Solitary Kidney

Children with a solitary kidney are at risk of developing hypertension due to decreased nephron number with a consequence of hyperfiltration of the remnant. In patients with high-risk conditions, ambulatory blood pressure monitoring (ABPM), which records blood pressure (BP) for 24 hours, is helpful in detecting hypertension.

PREVALENCE OF MASKED HYPERTENSION IN CHILDREN AND YOUNG ADULTS WITH CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Hypertension is a common complication and an important risk factor for adverse cardiovascular outcomes in patients with chronic kidney disease (CKD). Studies characterizing blood pressure status on young renal transplant recipients and young dialysis patients using ambulatory blood pressure monitoring are limited and report different prevalence rates. The aim of this meta-analysis was to estimate the prevalence of white-coat and masked hypertension in children and young adults with chronic kidney disease. Design and method: We performed a systematic review and meta-analysis of observational studies assessing the prevalence of blood pressure status using ambulatory blood pressure monitoring in children and young adults with chronic kidney disease. Records were identified by search in Medline, Scopus, and CENTRAL databases and sources of grey literature until December 2021. We conducted a random-effects meta-analysis of proportions (double arcsine transformation). Results: Overall, we included 10 studies with a total of 1140 children and young adults with CKD and a mean age of 13.79 ± 4.35 years. 301 and 76 patients presented masked hypertension and white-coat hypertension, respectively. We estimated an overall pooled masked HTN prevalence of 27% (95% CI: 18% to 36%, I2 = 87%) and an overall pooled prevalence of white-coat HTN of 6% (95% CI: 3% to 9%, I2 = 78%) (figure 2). Among renal transplant recipients masked HTN had a prevalence of 29% (95% CI: 14% to 47%, I2 = 86%). Further assessment of heterogeneity was qualitatively conducted. Conclusions: Masked hypertension is significantly prevalent in children and young adults with CKD, thereby warranting clinical attention when assessing cardiovascular risk in this population. Ambulatory blood pressure monitoring is of high importance when assessing blood pressure status in children with CKD.

Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association.

Use of ambulatory blood pressure monitoring in children and adolescents has markedly increased since publication of the last American Heart Association scientific statement on pediatric ambulatory blood pressure monitoring in 2014. In addition, there has also been significant expansion of the evidence base for use of ambulatory blood pressure monitoring in the pediatric population, including new data linking ambulatory blood pressure levels with the development of blood pressure-related target organ damage. Last, additional data have recently been published that enable simplification of the classification of pediatric ambulatory monitoring studies. This scientific statement presents a succinct review of this new evidence, guidance on optimal application of ambulatory blood pressure monitoring in the clinical setting, and an updated classification scheme for the interpretation of ambulatory blood pressure monitoring in children and adolescents. We also highlight areas of uncertainty where additional research is needed.

Ambulatory blood pressure monitoring in children during the COVID-19 pandemic.

The pandemic caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) had profound effects on healthcare delivery in the USA and abroad. Although ambulatory blood pressure monitoring (ABPM) is the recommended method for confirming hypertension (HTN) diagnosis and management, it is unclear how the pandemic affected ABPM utilization. We surveyed 81 pediatric nephrologists from 54 pediatric nephrology centers regarding their ABPM practices during the pandemic; 56.8% of providers continued to provide ABPM to their patients, but only 21% used disposable cuffs, and only 28.4% had specific equipment cleaning protocols in place. Only a minority of 81 practitioners felt comfortable (26.2%) or very comfortable (11.2%) in following published guidelines on ABPM during the pandemic, and 22.5% felt uncomfortable or very uncomfortable (7.5%). Additionally, only about half (49.4%) of practitioners were comfortable with managing HTN via telehealth. Our findings underscore the need to supplement existing and future guidance on how to manage HTN protocols, HTN patients, and equipment during healthcare crises.

Office Blood Pressure Monitoring in Children with Obesity and Obstructive Sleep Apnea

To investigate the relative contributions of obesity and obstructive sleep apnea (OSA) to unfavorable blood pressure in children. Children aged 3-18years with OSA-related symptoms were recruited. All children underwent office blood pressure (BP) monitoring and full-night polysomnography. Obesity was defined as a body mass index ≥95th percentile. OSA severity was divided into primary snoring (apnea-hypopnea index [AHI] <1), mild OSA (5> AHI ≥1), and moderate to severe OSA (AHI ≥5). Age- and sex-adjusted logistic regression analysis was performed to determine the associations among OSA, obesity, and elevated BP. This cross-sectional study enrolled 1689 children (66% boys), with a mean age of 7.9years. Compared with children with primary snoring, children with moderate to severe OSA had significantly higher systolic BP (108.1mmHg vs 105.6mmHg), diastolic BP (75.0mmHg vs 70.4mmHg), systolic BP percentile (75.0 vs 70.4), and diastolic BP percentile (74.0 vs 69.2). The rate of unfavorable BP (ie, elevated BP or hypertension level BP) also was significantly higher in children with more severe OSA. Children with obesity had higher BP and BP percentile. Logistic regression analysis revealed that children with obesity and moderate to severe OSA have a 3-fold greater risk of unfavorable BP compared with children without obesity and primary snoring. We identified a 3-fold greater risk of unfavorable BP in children with obesity and moderate to severe OSA.

Ambulatory Blood Pressure Monitoring in Children and Adults Prenatally Exposed to Dexamethasone Treatment.

ContextThe clinical use of dexamethasone (DEX) prenatally to reduce virilization of external genitalia in female fetuses with congenital adrenal hyperplasia (CAH) is efficient but still controversial. It remains challenging to prevent the excessive exposure of DEX in unborn healthy babies during the first trimester of pregnancy.ObjectiveSince endogenous glucocorticoids contribute to the maintenance of blood pressure (BP) and since events during fetal life may program the fetus and affect future metabolic health, the aim of this study was to analyze ambulatory BP measurements in CAH-unaffected children and adults that were prenatally exposed to DEX treatment.MethodsAmbulatory BP measurements were analyzed in 33 (16 female) DEX-treated participants aged 5.1 to 26.3 years (19 participants aged ≤ 18 years) and in 54 (28 female) age- and sex-matched apparently healthy controls aged 5.5 to 25.3 years (27 participants aged ≤ 18 years) with ambulatory normotension.ResultsParticipants’ age, height, weight, and body mass index were similar between the DEX-treated group and the control group. Heart rate, 24-hour BP, pulse pressure, and nighttime dipping did not statistically significantly differ between DEX-treated participants and controls.ConclusionOur study suggests that prenatal DEX treatment in CAH-unaffected children and adults does not appear to adversely affect ambulatory BP later in life. Our observations need to be confirmed in larger studies.

Nocturnal non-dipping on 24-h Ambulatory Blood Pressure Monitoring in children and adolescents with obesity is associated with higher total cholesterol levels

ABSTRACT Background Few studies indicate the occurrence of abnormal nocturnal dipping of blood pressure (BP) in 35–50% of children and adolescents with obesity. The relation between that phenomenon and metabolic complications of obesity remains unclear. To evaluate the association between disorders of glucose and lipid metabolism, and nocturnal non-dipping in pediatric patients with obesity. Methods In 207 children (53.14% girls, mean age 14 (range 2–17), mean BMI Z-SCORE 4.38, range 2.07–10.74) standard 24-h Ambulatory Blood Pressure Monitoring was performed. Normal dipping was defined as a ≥ 10% decline in BP during the night. Results There were 106 (51.21%) cases of non-dippers. The mean 24-h nocturnal systolic BP (SBP) reduction (%) was 9.9 ± 5.5. The mean 24-h nocturnal diastolic BP (DBP) reduction (%) was 15.8 ± 8.5. There was a significant correlation between BMI Z-SCORE and mean day-time SBP (r = 0.14 P = .042). There are positive correlations between 24-h heart rate (beats/min) and BMI Z-SCORE (r = 0.15, P = .027), between fasting glucose and systolic BP Z-SCORE (r = 0.17, P = .03) and between mean diastolic BP and LDL cholesterol (r = 0.23, P = .004). Total cholesterol level was significantly higher in non-dippers (4.34 vs. 3.99 mmol/L, P = .034). There were no significant differences between non-dippers and dippers regarding fasting glucose (4.6 vs. 4.8 mmol/L), 120ʹpost load glucose (5.7 vs. 5.9 mmol/L), insulin (19 vs. 20.2 µIU/mL), HOMA-IR (2.36 vs. 2.44), LDL cholesterol (2.64 vs. 2.51 mmol/L), HDL cholesterol (1.06 vs. 1.03 mmol/L) or triglycerides (1.36 vs. 1.34 mmol/L) levels. Conclusion Nocturnal non-dipping is frequent in pediatric patients with obesity. It is associated with higher total cholesterol levels.

Порушення ниркової й периферичної гемодинаміки в розвитку серцево-судинних розладів у дітей із хронічним пієлонефритом

Актуальність. Своєчасне виявлення змін з боку серцево-судинної системи в дітей із хронічним пієлонефритом важливе для уповільнення розвитку артеріальної гіпертензії, прогресування хронічної хвороби нирок. На сьогодні сучасними неінвазивними методами ранньої діагностики серцево-судинних порушень є добове моніторування артеріального тиску та ультразвукова допплерографія судин нирок. Мета: визначити прогностичне значення ультрасонографічної симптоматики порушень ниркової гемодинаміки та показників добового артеріального тиску в дітей із хронічним пієлонефритом. Матеріали та методи. Проведено кореляційний аналіз показників добового моніторування артеріального тиску та ультразвукового допплерографічного обстеження в 107 дітей із хронічним пієлонефритом віком 3–17 років. Результати. Статистично вірогідні зв’язки були виявлені між такими показниками: пульсаційним індексом, індексом резистентності, систоло-діастолічним співвідношенням на рівні стовбурової й сегментарних ниркових артерій і добовими індексами (артеріального тиску, систолічного й діастолічного тиску), коефіцієнтом варіації нічним, середнім діастолічним тиском та діастолічним тиском вночі. Кореляційні зв’язки між ультрасонографічними показниками ниркової гемодинаміки та добового моніторування артеріального тиску на рівні інтерлобарних ниркових артерій були статистично невірогідними. У дітей із хронічним пієлонефритом на фоні аномалій сечовивідних шляхів був найбільш сильний зв’язок між індексами периферичного опору на рівні стовбурової ниркової артерій та показниками добового моніторування артеріального тиску. Висновки. Показники ниркової гемодинаміки — пульсаційний індекс, індекс резистентності, систоло-діастолічне співвідношення на рівні стовбурової й сегментарних артерій нирки можуть бути використані для характеристики ниркової гемодинаміки й прогнозування розвитку ренальної АГ у дітей із хронічним пієлонефритом. У 57 % випадків вираженість відхилень цих показників від норми ниркової гемодинаміки визначає тяжкість артеріальної гіпертензії.

Blunt renal trauma-induced hypertension in pediatric patients: a single-center experience

Children have a greater chance of sustaining a renal injury than adults and higher odds of having a high-grade renal injury. Hypertension is a rare complication of blunt renal trauma, with risk being higher in cases of major renal trauma. We reviewed the cases of pediatric blunt renal trauma-induced hypertension in our tertiary referral center in an attempt to better understand this rare condition. A retrospective evaluation of children under the age of 18 who were admitted to our department during the last 20 years and were diagnosed with blunt renal trauma. Twenty-three children presented with blunt renal trauma, one of whom was treated with emergency nephrectomy. Four children (18%) developed post-traumatic hypertension. All four cases were associated with a reduction in blood flow to the kidney, either through injury to the renal artery (in three cases) or through extrinsic compression of the kidney by a large perirenal hematoma (Page kidney; in one case). The Page kidney case developed hypertension during the initial hospitalization, and it resolved spontaneously after five months through the gradual resorption of the perirenal hematoma. Among the three cases of renal artery injury, hypertension during the initial hospitalization was only observed in one case, with hypertension in the other two cases manifesting after two months and four years, respectively. All three cases of renal artery injury resulted in a complete loss of function of the injured kidney, and two cases were treated with nephrectomy. Following nephrectomy, the blood pressure level returned to normal within a few days. Development of hypertension following a blunt renal trauma can be heterogenous, with the time of manifestation stretching between days after the accident and years thereafter. Children have a higher risk of renal trauma and, according to published data out of the National Trauma Data Bank, a 20-times higher risk of renal artery injury in comparison to the adult population. Large multicenter studies are required to answer the question of whether children are therefore more prone to blunt renal trauma-induced hypertension than adults. Our study highlights the importance of blood pressure monitoring in children following blunt renal trauma, as post-traumatic hypertension can develop even years after the accident. In cases of a poorly functioning kidney, nephrectomy may be regarded as a curative therapy.

24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea.

To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA). Case series study. Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability. A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P=.002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P=.001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient=0.31, 95% CI=0.06-0.56, P=.015) after adjustment for age, gender, adiposity, and hypertensive status. OSA in children is associated with increased BP and BP variability. 4 Laryngoscope, 131:2126-2132, 2021.

Ambulatory blood pressure monitoring in children undergoing polysomnography.

Ambulatory blood pressure monitoring (ABPM) is recommended for the diagnosis of hypertension in children at high risk, such as children with obesity or obstructive sleep apnea (OSA). Nocturnal hypertension is highly predictive of cardiovascular outcomes. ABPM allows for early detection of nocturnal hypertension in children. Although OSA is the most common sleep disorder associated with hypertension, studies have also shown an increase in cardiovascular risk in adult patients with other sleep disorders; therefore, there is an imperative need to provide early diagnosis in children at high risk. In the present study, we evaluated the feasibility of using ABPM during polysomnography (PSG) in children referred for sleep disordered breathing to the Seattle Children's Hospital Sleep Disorders Center. A total of 41 children aged 7-18years were included in this study. The ABPM monitor was worn for a mean (SD) of 10.2(1.5)hr. No significant changes were seen in PSG parameters when ABPM was co-performed with PSG, including sleep efficiency and arousals. In total, 12 of the 41 patients were identified as having nocturnal hypertension. Our study is important in that it shows that concomitant use of ABPM during PSG can aid in the early identification of nocturnal hypertension in this population.

Proteinuria and Dipping on 24-Hour Ambulatory Blood Pressure Monitoring in Children

Proteinuria and Dipping on 24-Hour Ambulatory Blood Pressure Monitoring in Children