Ambulatory blood pressure monitoring is gold standard for diagnosing hypertension in children

With hypertension diagnoses on the rise in children, ambulatory blood pressure monitoring is crucial.

The National Health and Nutrition Examination Survey (NHANES) estimates that 19.3% of U.S. children ages 2 to 19 have obesity, including 6.1% with severe obesity, and another 16.1% are overweight. The current prevalence of high blood pressure (BP) in children is 11% and is expected to rise.

Ambulatory blood pressure monitoring (ABPM) is the gold standard for pediatric hypertension diagnosis and treatment according to American Academy of Pediatrics (AAP) guidelines. Norton Children’s Nephrology, affiliated with the UofL School of Medicine, offers ambulatory blood pressure monitoring via the Norton Children’s Pediatric Hypertension Program.

ABPM in children is accomplished using a special device where a blood pressure cuff is worn on the arm and attached to a small recording device (the size of a portable MP3 player) the child can wear. The child wears the device for 24 hours, recording the blood pressure usually at 15-minute intervals during the daytime and 30-minute intervals at night. Patients are encouraged to continue their normal activities while recording and to note the time of those activities.

Using ABPM to confirm hypertension diagnosis

Children with BP in range of the 90th to 95th percentile for systolic blood pressure (SBP) at 120 to 129 (mm Hg) in ages 13 and older should be referred to a pediatric nephrologist for ABPM at the 12-month mark after three elevated BP readings. A child with stage 1 hypertension symptoms, BP in range of greater than 95th percentile but less than 95th percentile plus 12 mm Hg or SBP between 130 to 139 in ages 13 or older, should receive ABPM with a pediatric nephrologist in three months from the initial BP reading.

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Norton Children’s Nephrology has the largest ABPM program in Louisville and Southern Indiana. As of May, Norton Children’s Nephrology has performed on average 18 ABPM studies per month in 2021. Our pediatric nephrologists follow the AAP standards regarding the four basic uses for ABPM in the pediatric population:

  • Confirm diagnosis of hypertension.
  • Differentiate “white coat hypertension” (higher blood pressure readings when taken in a health care setting like a doctor’s office than a reading in a home or other setting) from true hypertension.
  • Determine severity of hypertension (moderate versus severe).
  • Evaluate blood pressure control on medication and lifestyle.

Once a diagnosis is confirmed, we work with children and families on patient education to create an individualized plan to lower BP. We work to build collaborative relationships with families to set realistic goals and expectations for lifestyle changes, including dietary approaches such as the DASH diet and limiting sugary drinks.


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