Ambulatory Blood Pressure Monitoring in Children: Single Center Experience

Objective: Ambulatory blood pressure monitoring (ABPM) is the preferred method for diagnosis of hypertension(HT) in children. Here, we aimed to demonstrate the reasons for ABPM application and incidence of HT, white coat and masked HT in our cohort besides the evaluation of dipping status, biochemical and radiological parameters between the patients with normotension, elevated blood pressure(EBP) and HT. Material and Methods: Twenty-four hour ABPM results of children followed at department of pediatric nephrology and whose office blood pressure measurements revealed HT or EBP and ABPM records of normotensive patients having chronic kidney disease or renal anomalies were evaluated retrospectively. Twenty-four hour ABPM SD score ≥1.96 defined HT while the value between 1.64 and 1.95 indicated EBP. In addition to assessment of blood pressure loads and nocturnal dipping; age, gender, body mass index(BMI), proteinuria, kidney function tests and ultrasound of urinary system were also assessed. Results: Although ABPM was applied to total of 244 patients, 189 of them were included in the study. High casual blood pressure measurements in 108 (57.1%) asymptomatic patients constituted the major group for ABPM application. Total of 57 patients (30.2%) were normotensive, 18 (9.5%) with EBP and 114 (60.3%) were hypertensive. No difference was found in regards of BMI, proteinuria, serum creatinine levels and sonographic results between the groups. Patients with HT and EBP had significantly lower nocturnal dip than normotensive group (p<0.001). However there was no difference in number of patients with inadequate nocturnal fall in all three groups. Conclusion: ABPM should be preferred for definitive diagnosis of HT in childhood. Patients with inadequate nocturnal fall should be evaluated carefully and followed-up regularly as it had been implicated in the development of cardiovascular disease.