Utility of ambulatory blood pressure monitoring in the evaluation of elevated clinic blood pressures in children

Although ambulatory blood pressure monitoring (ABPM) is recognized for its role in assessing white coat hypertension, other uses include evaluation of treatment adequacy, nocturnal hypertension, dipping status, and hypertension severity. We performed a retrospective study of ABPMs completed at a single center from November 2007 to October 2011 to determine the frequency of white coat hypertension, prehypertension, and hypertension in children and the correlation of these findings with office BPs. A total of 247 ABPMs were performed in 206 children, ages 4–20 years, including 48 recordings in 39 diabetic patients and 64 recordings in treated hypertensive patients. We found a poor correlation between hypertensive status based on clinic BP and diagnosis on ABPM, and evidence for a white coat effect. Among treated patients, ABPM results resulted in medication changes in 63%. We conclude that ABPM is a useful tool for characterizing hypertensive status and treatment adequacy in children.