Kidney Week

Abstract: PUB434

Multiple Office Blood Pressure Measurement for Hypertension Diagnosis in Children

Session Information

• Publication Only

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Dato, Letizia, Università del Piemonte Orientale, Division of Pediatrics, Department of Health Sciences, Novara, Italy

Letizia Dato, MD

• Mancuso, Maria Cristina, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplantation Unit, Milan, Italy

Maria Cristina Mancuso, MD

• Viola, Laura, Ospedale di Stato, ISS San Marino, Pediatric Unit, San Marino, San Marino

Laura Viola

• Tamburini, Giacomo, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplantation Unit, Milan, Italy

Giacomo Tamburini

• Rossetti, Daniele, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplantation Unit, Milan, Italy

Daniele Rossetti

• Gualtieri, Andrea, ISS San Marino, Health Authority, San Marino, San Marino

Andrea Gualtieri, APN

• Ardissino, Gianluigi, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplantation Unit, Milan, Italy

Gianluigi Ardissino, MD, PhD

Background

Blood pressure (BP) measurement (M) in children may be challenging. International guidelines suggest measuring BP 3 times. In a previous study, we reported that the first 3 readings are unreliable. At our Centre, multiple Office BPM (mOBPM) is the standard practice for hypertension diagnosis in children since 2010. It consists of 10 serial readings taken at 3-minute intervals using a validated automated oscillometric device. After discarding outlier readings (<5th and >95th centile), the coefficient of variation (CV) and the remaining systolic (S) and diastolic (D) BP means are calculated by a software. This contribution is aimed at testing mOBPM in a children cohort to bolster its use as a practical tool to assess BP in children.

Methods

School children underwent mOBPM at baseline and after 12 months. After excluding series with a CV>15%, the mean SBP and DBP values obtained by mOBPM were compared with each of the first 4 M (t test for paired data). The number of children with BP>90th centile within those M was also determined.

Results

One hundred and seventy-five children (93 females, 53%) with a mean age of 8.6±0.3 and a mean BMI of 17.5±2.9 (BMI>20 n=34; 19%) were enrolled. Thirteen mOBPM were excluded for a CV>15% in SBP or DBP. As represented in Figure 1, the remaining 328 mOBPM showed that the mean of the first 3 SBP and DBP values were higher (p<0.001) than those obtained with mOBPM. The same held true for the mean of the 2nd and 3rd M, whereas the 4th was the first one not significantly different from mOBPM. The number of children with BP>90th centile by each reading and by mOBPM is also provided.

Conclusion

Relying on the first 3 M overestimates the number of hypertensive subjects, prompting unnecessary diagnostic and therapeutic pathways. The 4th is more reliable but mOBPM provides a better evaluation of BP particularly when initial readings show higher than normal values.