Kidney Week

Abstract: FR-PO388

Multiple Office Blood Pressure Measurement (mOBPM): A Practical Application for Hypertension Diagnosis in Children

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

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

In children office blood pressure (BP) measurement (M) may be unreliable. Multiple office BPM (mOBPM) is the standard practice for hypertension diagnosis in children at our Centre. It consists in taking 10 serial readings at 3-minute intervals by mean of a validated automated oscillometric device, discarding outlier values (<5th and >95th centile), calculating the coefficient of variation (CV) and the mean of the remaining systolic (S) and diastolic (D) BP values through a software. In a previous study, we reported that the first 3 readings are significantly higher than the mOBPM mean, whereas, starting from the 4th one, we found no significant difference. The mOBPM identified a smaller number of subjects with abnormal BP values. This study aimed to test mOBPM as a simple yet effective approach to screen children for hypertension.

Methods

We determined the number of school children with BP>90th centile considering the first 3 readings and the mean of the 2nd and 3rd. Among these, we identified children with pathological BP at 4th M and, subsequently, at mOBPM. Hence, we compared this result with the number of truly hypertensive children confirmed at the mOBPM repeated at 12 months.

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) were enrolled. Thirteen children were excluded for a CV>15% in SBP or DBP. Figure 1 shows the results. The mean of the 2nd and 3rd M identified 14 children with BP>90th centile, but the 4th showed a further reduction of the number of falsely hypertensive subjects and remains a more practical approach. None of the children with a normal BP value at 4th reading showed a pathological mOBPM result.

Conclusion

Although guidelines recommend 3 readings, our findings suggest that, if the first 3 readings indicate elevated BP values, measuring a 4^th value can unmask falsely hypertensive subjects. If the 4^th reading is abnormal, we recommend to obtain a complete mOBPM to identify truly hypertensive children.