Reproducibility and validity of ambulatory blood pressure monitoring in children

During the past several years ambulatory blood pressure monitoring (ABPM) has been introduced into the study of hypertension and has become a useful tool in making clinical decisions. The ABPM improves the reproducibility of the estimates of a subject's casual blood pressure (BP) both in normotensive and in hypertensive subjects, independent of age. The advantages of ambulatory BP (ABP) over its office counterpart have been studied in children to observe the relationship between BP measurement and early markers of organ damage. In different groups of subjects that have included normotensives, essential hypertensives, renal transplant recipients, or patients with repair of an aortic coarctation, averages of ambulatory systolic BP appear to have the best correlation with left ventricular mass. Moreover, a positive relationship between microalbuminuria and ABP was also observed in a high-risk population with type I diabetes. The assessment of prognostic value of ABPM in children is more difficult because the surrogate end points take time to develop. Pediatric populations with a high risk of developing organ damage markers in a relatively short period of time should be the focus of such studies. Even given its apparent advantage over office BP measurements, much work needs to be carried out so as to better establish the validity and more precise use of ABPM in children.