Falkner B, Kushner H, Katz S
Birth weight, childhood growth, and adult blood pressure in African Americans
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Sep) 7:1549 1996

In adults, the use of ambulatory BP monitoring has rapidly escalated and a body of information is available on normative values at different ages. Furthermore, several trials are ongoing in Europe which use ambulatory monitoring as a tool to evaluate cardiovascular outcome. A much smaller but expanding data set is available for children. especially nonadolescents. This is a small descriptive study of the utility of ambulatory blood pressure monitoring in children.

The authors reviewed 20 studies done in children ages 4 to 17 years. The blood pressure averages were compared to the Second Task Force BP standards in children. They defined as hypertensive children with 50% of both systolic and diastolic readings above the 95 th percentile for the age or greater than 75% systolic greater than the 95 th percentile.

Thirteen children were studied because of elevated office or home readings. Of this group, 7 had abnormal monitor studies and were treated, while 6 were considered normal (i.e. white-coat hypertensive). The other 7 were studied to assess overall blood pressure control and were considered to have good control based on office or home readings. Of these only 3 had normal studies and the other four required changes of their medication schedule. Of the overall group, 50% of the children provided monitoring information which was unexpected.

Comment: The normal range for ambulatory blood pressure in children deserves further study. One cannot translate office readings directly into ambulatory averages. Furthermore, the reproducibility of ambulatory BP monitoring as well as its tolerability is probably less than adults. However, in selected cases BP monitoring may provide useful information. (George Mansoor, M.D., University of Connecticut)

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Am Soc Nephrol
H: Pathophysiology : Fetal origins, birth weight
H: Special problems : Ethnic populations