AHA Recommends 24-Hour BP Monitoring for Children With Hypertension

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Title: AHA Recommends 24-Hour BP Monitoring for Children With Hypertension
URL: http://www.pslgroup.com/dg/22742A.htm
Doctor's Guide
August 6, 2008

DALLAS -- August 6, 2008 -- The American Heart Association (AHA) now recommends 24-hour blood pressure monitoring for certain children and adolescents suspected of having high blood pressure or a condition that causes unreliable readings at the doctor's office.

The statement, published in Hypertension, is expert-opinion driven and not evidence-based. That's because studies relating 24-hour monitoring in children to hard outcomes like heart attack and stroke are not yet available.

"The most important take-home message is that clinical hypertension can be identified in children and adolescents and is associated with organ damage even at young ages," said Elaine Urbina, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. "Therefore, accurate diagnosis and early treatment is essential."

"There is now sufficient experience with ambulatory blood pressure monitoring (ABPM) to recommend its use in paediatric patients to assist in diagnosing hypertension," she said.

The AHA recommends using ABPM to rule out white coat hypertension and masked hypertension. Researchers found white coat hypertension in 22% to 88% of children studied.

It can also be useful for evaluating the effectiveness of hypertension medications, observing whether blood pressure decreases at night during sleep, and evaluating apparent drug-resistant hypertension.

"Ambulatory monitoring is likely to be most useful in children whose office blood pressure readings are up to 10% over the highest acceptable reading, as children with very high readings were more likely to have true high blood pressure," said Dr. Urbina.

Because the use of ABPM in children is relatively new, there are little data on the technology's predictive ability. But the committee recommends ABPM based on evidence of its usefulness in specific situations.

"The global obesity epidemic is linked with increasing blood pressure levels in young people," said Dr. Urbina. "In addition, blood pressure levels at the higher end of the spectrum in the early years tend to track into adulthood and might lead to the development of hypertension."

The statement includes recommendations for doctors on choosing an ABPM machine and caring for the equipment, as well as guidelines on fitting cuffs to paediatric patients. It also suggests that ABPM be performed only by personnel trained to use the device and interpret its data in children.

While the AHA recently recommended home monitoring for adults with high blood pressure, the statement said ABPM had better diagnostic specificity for children compared to home measurement.

SOURCE: The American Heart Association

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