AHA Updates Pediatric Ambulatory Blood Pressure Monitoring Recommendations

The American Heart Association (AHA) has updated their scientific statement on the use and classification of ambulatory blood pressure monitoring (ABPM) in children and adolescents.

These changes come as an update to the group’s 2014 statement. New research suggests that elevated blood pressure (BP) in childhood may be associated with an increased risk for both heart disease in adulthood and BP-related target organ damage (TOD), among other adverse events.

The statement emphasizes that ABPM may provide a more-accurate measurement of BP by reducing the risk of white coat hypertension, and more accurately measuring masked hypertension or nocturnal hypertension in patients with chronic conditions.

Among the recommendations included in this update:

• ABPM should be used to confirm a hypertension diagnosis before initiating antihypertensive medication
• Only oscillometric or auscultatory ABP devices are to be used in pediatric populations
• The revised system for classifying ABPM in pediatric patients no longer includes the use of BP load

The writing committee notes that knowledge gaps on the use of ABPM exist in the equipment used, availability of normative data, and interpretation of ABPM readings, among other areas.

“Even recognizing that these gaps exist, and that ABPM may not be universally available, ABPM is clearly an important technique that adds precision to the evaluation and management of the young patient with elevated BP,” authors concluded. “It is hoped that this scientific statement will assist pediatric practitioners in applying these techniques in their own clinic populations.”

—Leigh Precopio

Reference:

Flynn JT, Urbina EM, Brady TM, et al. Ambulatory blood pressure monitoring in children and adolescents: 2022 update: a scientific statement from the American Heart Association. Hypertension. Published online May 23, 2022. https://www.ahajournals.org/doi/10.1161/HYP.0000000000000215