Blood pressure, hypertension, and ambulatory blood pressure monitoring in children and adolescents

Fixed essential hypertension in children is uncommon. Confusion surrounding the definitions and tools used in measuring blood pressure (BP), and the variable capacity to apply the definitions despite the device used explains this in part. In children, hypertension is defined statistically, based on a large normative population that is ethnically diverse. The standards were developed from the first BP measurement obtained in large studies, and the measurements were obtained using standard auscultatory sphygmomanometry. Technologic advances have seen the widespread introduction of oscillometric devices, which determine BP in a different fashion from auscultation, and the two values are not identical. In fact, as oscillometric devices use proprietary algorithms to calculate the BP, results are not readily interchangeable. Ambulatory BP devices have been added to this mix and offer unique opportunities for accurate diagnosis, and more effective therapies. Most ambulatory BP devices have neither been validated for use in children, nor have passed the validation process. A consensus document may be needed to optimize use and interpretation of data from ambulatory BP monitoring.