Home Doppler blood pressure monitoring in infants and children: a pilot study of its feasibility and clinical utility

BACKGROUND: Out-of-hospital measurements of blood pressure (BP) are important for investigating and managing hypertension, but information is limited regarding the right technique to use in infants, small children and those intolerant of ambulatory BP monitoring. The aim of the study was to determine the feasibility and clinical utility of home Doppler BP monitoring (HDBPM). METHODS: This single-centre study included all consecutive patients referred to a tertiary hypertension clinic who underwent HDBPM over a 12-month period. Parents were taught to measure systolic BP using a Doppler instrument. RESULTS: HDBPM was successfully performed in 15 children (median (IQR) age 2.2 (0.9-3.7) years). All six patients referred for confirmation of newly diagnosed hypertension following sustained elevated clinic BP levels were found to be normotensive. Of the nine children referred with 'treated hypertension' for monitoring currently elevated clinic BP levels, four had confirmed hypertension and five were normotensive on HDBPM. In all nine 'treated hypertensive' patients, medication changes and normotensive BP levels were achieved with on-going home Doppler monitoring. 11/15 (73.3%) subjects successfully performed ≥1 BP measurement on at least 24 days of the 28-day monitoring period. The median (IQR) number of BP measurements performed weekly through week 4 of HDBPM were 22 (13-36), 18 (12-38), 18 (11-36) and 16 (8-32) respectively. No patient was hospitalised for further BP monitoring. CONCLUSIONS: HDBPM is acceptable to children and their families, demonstrating its feasibility as an out-of-office measurement technique. The initial results and the reliability of HDBPM need to be explored in larger clinical studies.