Abstract
Ambulatory blood pressure monitoring (ABPM) provides superior information for diagnosis and treatment of pediatric hypertension, but for reasons of practicality, clinic blood pressure measurements (CBP) are still the primary diagnostic tool. Regular home blood pressure measurements (HBP) may be an alternative to ABPM, but this technique awaits validation in practice. We analyzed the concordance of ABPM, CBP and HBP in 118 pediatric patients (3-19 y) with chronic renal failure. HBP readings (10.5 ± 5.4 per patient) were averaged for one week around the day of ABPM and CBP. Mean arterial pressure (MAP) measured by HBP (84.0 ± 10 mm Hg) was significantly lower than both CBP (86.1 ± 14.1 mm Hg, P < 0.05) and daytime ABPM (90.3 ± 10.4 mm Hg, P < 0.05). HBP detected hypertensive patients with greater specificity (82 versus 70%), but lower sensitivity (52 versus 70%) than CBP. The fraction of patients rated erroneously hypertensive was 23% with CBP, but only 14% with HBP. The 95% limits of agreement with ABPM were narrower for HBP (-23 to10 mm Hg) than for CBP (-30 to 21 mm Hg). CBP, but not HBP measurements, were less precise in the upper BP range. The accuracy of HBP measurements did not change with use over a six months time period. In conclusion, HBP was superior to CBP in predicting ABPM, but neither CBP nor HBP detected hypertension with enough sensitivity or specificity to replace ABPM. The greater specificity of HBP compared with CBP makes it a more suitable tool for diagnosis, rather than screening, of hypertension in children.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Abbreviations
- ABPM:
-
ambulatory blood pressure monitoring
- BP:
-
blood pressure
- CBP:
-
clinic (also casual or office) blood pressure
- HBP:
-
home blood pressure
- MAP:
-
mean arterial pressure
REFERENCES
Klahr S, Levy AD, Beck GJ 1994 The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 330: 877–884
Wingen AM, Fabian-Bach C, Schaefer F, Mehls O 1997 Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet 349: 1117–1123
Mancia G, Parati G 2000 Ambulatory blood pressure monitoring and organ damage. Hypertension 36: 894–900
Liu M, Takahashi H, Morita Y, Maruyama S, Mizuno M, Yuzawa Y, Watanabe M, Toriyama T, Kawahara H, Matsuo S 2003 Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients. Nephrol Dial Transplant 18: 563–569
Mule G, Caimi G, Cottone S, Nardi E, Andronico G, Piazza G, Volpe E, Federico MR, Cerasola G 2002 Value of home blood pressures as predictor of target organ damage in mild arterial hypertension. J Cardiovasc Risk 9: 123–129
Chobanian AV, Barkis GL, Black DL, Cushman WC, Green LA, Izzo JLJ, Jones DW, Materson BJ, Oparil S, Wright JTJ, Roccella EJ 2003 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 289: 2560–2571
Barker ME, Shiell AW, Law CM 2000 Evaluation of the Dinamap 8100 and Omron M1 blood pressure monitors for use in children. Paediatr Perinat Epidemiol 14: 179–186
Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Rascher W, Reusz GS, German Working Group on Pediatric Hypertension 2002 Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20: 1995–2007
de Man SA, André JL, Bachmann HJ, Grobbee DE, Ibsen KK, Laaser U, Lippert P, Hofmann A 1991 Blood pressure in childhood: pooled findings of six European studies. J Hypertens 9: 109–114
Zuther P, Witte K, Lemmer B 1996 ABPM-Fit and CV-Sort: an easy-to-use software package for detailed analysis of data from ambulatory blood pressure monitoring. Blood Press Monit 1: 347–354
Bland JM, Altman DG 1986 Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I: 307–310
White WB, Asmar R, Imai Y, Mansoor G, Padfield P, Thijs L, Waeber B 1999 Task Force VI: Self-monitoring of the blood pressure. Blood Press Monit 4: 343–351
Herpin D, Pickering TG, Stergiou GS, de Leeuw PW, Germano G 2000 Consensus Conference on Self-blood pressure measurement. Clinical applications and diagnosis. Blood Press Monit 5: 131–135
Lingens N, Freund M, Seeman T, Witte K, Lemmer B, Scharerk K 1997 Circadian blood pressure changes in untreated children with kidney disease and conserved renal function. Acta Pediatr 86: 719–723
James GD, Pickering TG, Yee LS, Harshfield GA, Riva S, Laragh JH 1988 The reproducibility of average ambulatory, home and clinic pressures. Hypertension 11: 545–549
Lurbe E, Redon J 2002 Reproducibility and validity of ambulatory blood pressure monitoring in children. Am J Hypertens 15: 69S–73S
Stergiou GS, Zourbaki AS, Skeva II, Mountokalakis TD 1997 White coat effect detected using self-monitoring of blood pressure at home: comparison with ambulatory blood pressure. Am J Hypertension 11: 820–827
Hond ED, Celis H, Fagard R, Keary L, Leeman M, O'Brien E, Vandenhoven G, Staessen JA, THOP investigators 2003 Self-measured versus ambulatory blood pressure in the diagnosis of hypertension. J Hypertens 21: 717–722
Masding MG, Jones JR, Bartley E, Sandeman DD 2001 Assessment of blood pressure in patients with Type 2 diabetes: comparison between home blood pressure monitoring, clinic blood pressure measurement and 24-h ambulatory blood pressure monitoring. Diabet Med 18: 431–437
Stergiou GS, Efstathiou SP, Argyraki CK, Gantzarou AP, Roussias LG, Mountokalakis TD 2002 Clinic, home and ambulatory pulse pressure: comparison and reproducibility. J Hypertens 20: 1987–1993
Vetter W, Hess L, Brignoli R 2000 Influence of self-measurement of blood pressure on the responder rate in hypertensive patients treated with losartan: results of the SVATCH study. Standard vs Automatic Treatment Control of COSAAR in hypertension. J Hum Hypertens 14: 235–241
Nordman A, Frach B, Walker T, Martina B, Battegay E 2000 Comparison of self-reported home blood pressure measurements with automatically stored values and ambulatory blood pressure. Blood Press 9: 200–205
Bald M, Hoyer PF 2001 Measurement of blood pressure at home: survey among pediatric nephrologists. Pediatr Nephrol 16: 1058–1062
Verdeccia P 2001 Reference values for ambulatory blood pressure and self-measured blood pressure on prospective outcome data. Blood Press Monit 6: 323–327
Jula A, Puukka P, Karanko H 1999 Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring. Hypertension 34: 261–266
Matsuoka S, Kawamura K, Honda M, Awazu M 2002 White coat effect and white coat hypertension in pediatric patients. Pediatr Nephrol 17: 950–953
Mitsnefes MM, Kimball TR, Daniels SR 2003 Office and ambulatory blood pressure elevation in children with chronic renal failure. Pediatr Nephrol 18: 145–149
Covic A, Goldsmith DJ, Covic M 2000 Reduced blood pressure diurnal variability as a risk factor for progressive left ventricular dilatation in hemodialysis patients. Am J Kidney Dis 35: 617–623
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Support for this study was obtained from the European Union (5th Framework Programme, QLG1-CT-2002-00908), the Boehringer Ingelheim Foundation, the Baxter Extramural Grant Program, and Aventis Pharma.
APPENDIX
APPENDIX
Members of the ESCAPE (Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients) Trial Group. A. Anarat (Adana), A. Bakkaloglu (Ankara), A. Peco-Antic (Belgrade), U. Querfeld,
J. Gellermann (Berlin), P. Sallay (Budapest), D. Drozdz (Crakow), K.-E. Bonzel, A.-M. Wingen (Essen), A. Zurowska (Gdansk), F. Perfumo, A. Canepa (Genoa), D.E. Müller-Wiefel, K. Zepf (Hamburg), G. Offner, B. Enke (Hannover), O. Mehls, F. Schaefer, E. Wühl, C. Hadtstein (Heidelberg), U. Berg, G. Celsi (Huddinge), S. Emre, A. Sirin, I. Bilge (Istanbul), S. Çaliskan (Istanbul-Cerrahpasa), S. Mir, E. Serdaroglu (Izmir), C. Greiner, H. Eichstädt (Leipzig), K. Hohbach-Hohenfellner (Mainz), N. Jeck (Marburg), A. Appiani, G. Ardissino, S. Testa (Milano), G. Montini (Padova), P. Niaudet, M. Charbit (Paris), J. Dusek (Prague), A. Caldas-Afonso (Porto), S. Picca, C. Matteucci (Rome), M. Wigger (Rostock), M. Fischbach, J. Terzic (Strasbourg), J. Fydryk, T. Urasinski (Szezecin), R. Coppo, L. Peruzzi (Torino), A. Jankauskiene (Vilnius), M. Litwin, M. Abuauba, R. Grenda (Warszawa), K. Arbeiter (Vienna), T.J. Neuhaus (Zurich).
Rights and permissions
About this article
Cite this article
Wühl, E., Hadtstein, C., Mehls, O. et al. Home, Clinic, and Ambulatory Blood Pressure Monitoring in Children with Chronic Renal Failure. Pediatr Res 55, 492–497 (2004). https://doi.org/10.1203/01.PDR.0000106863.90996.76
Received:
Accepted:
Issue date:
DOI: https://doi.org/10.1203/01.PDR.0000106863.90996.76
