BACKGROUND
Similar to adults, in children automated cuff devices are recommended for office, home, and ambulatory blood pressure (BP) measurement. However, a device validated in adults may not be accurate in children, and separate investigation is necessary. Moreover, current pediatric guidelines recommend hypertension detected by an automated device to be confirmed using auscultation. The evidence on validated automated BP devices for children (aged 3-12 years) is presented.
METHODS
STRIDE BP (Science and Technology for Regional Innovation and Development in Europe-Blood Pressure; www.stridebp.org) performs periodic systematic PubMed searches for validation studies of automated BP devices. The data set of studies including children was analyzed.
RESULTS
Fifty-one of 628 studies in the STRIDE BP database included children. Forty-one (80%) concluded that the test device passed the validation, yet due to protocol violations, STRIDE BP approved 22 of them (43%). These 22 studies validated 20 devices (14 on the market). Seven additional devices had measurement functions equivalent to STRIDE BP-approved devices (6 on the market). Meta-analysis of 20 successful studies including children and older individuals (N=1476) showed a pooled test-reference systolic BP difference of 0.6 mm Hg (95% CI, -0.2 to 1.4), and diastolic -0.3 (95% CI, -1.2 to 0.6). Meta-analysis of 7 studies including only children (N=410) showed a pooled difference of 1.0 (95% CI, -0.7 to 2.8)/-1.3 (95% CI, -2.9 to 0.4) mm Hg.
CONCLUSIONS
There is a severe shortage of validated automated BP device models for children, with published studies often having methodological issues. Some devices are validated in children and, as in adults, can replace auscultatory devices for office hypertension diagnosis. There is an urgent need for more automated BP devices to be validated in children.
George S. Stergiou, A. Menti, P. Palatini et al.· HYPERTENSION· 0 citations
BACKGROUND
Circadian blood pressure (BP) phenotypes are associated with cardiovascular risk, though understudied in youth. This study in young individuals investigated the association of nighttime BP with measures of hypertension mediated organ damage (HMOD), primary endpoint of interest in this low absolute cardiovascular risk population.
METHODS
Individuals aged 6-25 years were evaluated with 24-h ambulatory BP monitoring (ABPM). HMOD investigation included echocardiographic left ventricular mass index (LVMI) and ultrasonographic common carotid artery intima-media thickness (IMT).
RESULTS
Two hundred and seventy-six individuals were included (mean age 13.8 ± 3.8 years, 67% males) with ABPM data (23.6% ABPM hypertension, 26.4% nighttime hypertension, 30.4% non-dippers) and LVMI (n = 257) and/or IMT (n = 205). BP and HMOD indices increased with age, whereas non-dipping prevalence was not associated with age. Non-dippers vs. dippers had higher LVMI (30.5 ± 8.2 vs. 28.4 ± 5.95 g/m2.7, P = 0.01) and IMT (0.52 ± 0.05 vs. 0.50 ± 0.05 mm, P = 0.02), adjusted for age, sex, body mass index z-score (BMIz) and 24-h systolic BP (SBP). Individuals with nighttime hypertension vs. nighttime normotension had higher LVMI (32.76 ± 8.02 vs. 27.69 ± 5.65 g/m2.7, P < 0.001) and a trend towards higher IMT (0.52 ± 0.06 vs. 0.50 ± 0.05 mm, P = 0.16), adjusted for age, sex and BMIz. Dippers and non-dippers with nighttime hypertension had higher LVMI than dippers with nighttime normotension (all P < 0.05). In multivariable models, non-dipping independently associated with LVMI/ IMT (β = -2.14/-0.02, all P < 0.05), after adjustment for 24-h SBP, but not for nighttime SBP (β = -0.9/-0.01, for LVMI/IMT, respectively, all P = NS).
CONCLUSIONS
In young individuals asymptomatic HMOD is associated with both nocturnal hypertension and non-dipping. However, nighttime BP levels seem to have the primary contributing role.
Aikaterini G. Theodosiadi, A. Kollias, E. Stambolliu et al.· Journal of Hypertension· 0 citations