Out-of-Office Blood Pressure Monitoring in the Pediatric Population: Current Evidence and Pitfalls

Out-of-office blood pressure (BP) measurement is essential for the accurate diagnosis and longitudinal management of hypertension in children and adolescents, yet evidence supporting modalities beyond ambulatory BP monitoring (ABPM) remains limited. This review synthesizes current pediatric evidence on out-of-office BP measurement approaches, including ABPM, home BP monitoring with cuff and cuffless devices, and community-based measurements, highlighting their advantages, limitations, and key evidence gaps. ABPM remains the only modality recommended for diagnostic confirmation in youth, owing to its superior reproducibility, ability to characterize BP phenotypes, and strong associations with target organ injury and future cardiovascular disease risk. However, access to ABPM is constrained by cost, limited availability of validated pediatric devices and cuff sizes, specialized expertise requirements, and patient tolerability concerns. Home BP monitoring and community-based measurements may enhance access and support ongoing management but place substantial responsibility on families and are not recommended for diagnosis. Across all modalities, the scarcity of BP devices validated for pediatric use represents a major barrier to equitable care. Future research should prioritize rigorous validation of pediatric BP devices, evaluation of feasibility and effectiveness of home and community-based strategies, and development of approaches that reduce burden on families while improving access to accurate BP assessment in youth.