Impact of ambulatory blood pressure monitoring on the diagnosis of hypertension in children

• We have compared two methods for the classification of hypertension in children.
• There are differences between ambulatory blood pressure monitoring (ABPM) interpretation scheme and IV Report criteria.
• ABPM detects the cases of masked hypertension and white coat hypertension.
• ABPM minimizes the misplacement of prehypertensive children.
• However, ABPM leaves uncategorized 14% of children.

Screening of hypertension in children commonly starts with office measurement of the blood pressure according to the Fourth Report. The latter however does not account for masked hypertension (MH) on the one hand and white coat hypertension (WCH) on the other. We aimed to investigate in a single large pediatric population how much the addition of ambulatory blood pressure monitoring (ABPM) helps to refine the allocation to the different classes of blood pressure. In a retrospective study, we reclassified the records of a cohort of 500 children, who attended our department for investigation of possible hypertension, according to the Fourth Report and the revised ABPM interpretation scheme. As expected, ABPM interpretation scheme detected MH and WCH; however, 14% of children evaluated according to this scheme did not fit in any categories. On the other hand, applying the Fourth Report criteria, 80% of prehypertensive children ended up in the uncategorized or the MH groups. Our data confirm that ABPM detects the cases of MH and WCH, and minimizes the misplacement of prehypertensive children; unfortunately however, it also leaves a significant number of patients remain unclassified.