BACKGROUND Ambulatory blood pressure monitoring (ABPM) measures mean arterial pressure (MAP) then extrapolates systolic and diastolic blood pressure (BP) values. Pediatric guidelines recommend using calculated systolic and diastolic BP rather than measured MAP for diagnosis of ambulatory hypertension (HTN). The 95th percentile BP that defines ambulatory HTN is higher in some children than thresholds used to define ambulatory HTN in adults. METHODS This is a retrospective study of patients who underwent 24-h ABPM. The level of agreement in ambulatory HTN diagnosis using MAP vs. systolic/diastolic BP was evaluated using Cohen's kappa coefficient. Similar analysis was done to assess agreement in HTN diagnosis using adult vs. pediatric criteria for males taller than 165 cm. RESULTS A total of 263 ABPM studies were included. There was good agreement for diagnosis of HTN using MAP or systolic/diastolic BP (k = 0.75; 95% CI: 0.67-0.83). However, there was disagreement between the methods in 12% (n = 31) of subjects. Similarly, there was good agreement (k = 0.70; 95% CI: 0.56-0.85) between pediatric and adult criteria for HTN diagnosis. Nineteen patients were found to be hypertensive (9 using MAP criteria, 10 using adult criteria) who would not have met ambulatory HTN criteria using current pediatric guidelines. CONCLUSIONS Inclusion of MAP along with systolic and diastolic BP in ABPM analysis alongside using adult criteria for diagnosing HTN in male children ≥ 165 cm may improve accuracy of pediatric HTN diagnosis and reduce false negative rate. Larger studies are needed to assess the clinical validity of these results. Graphical abstract.

中文翻译：

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使用动态血压监测诊断小儿高血压的挑战。

背景动态血压监测（ABPM）测量平均动脉压（MAP），然后推断收缩压和舒张压（BP）值。儿科指南推荐使用计算的收缩压和舒张压而不是测量的 MAP 来诊断动态高血压 (HTN)。在某些儿童中定义动态 HTN 的第 95 个百分位 BP 高于用于定义成人动态 HTN 的阈值。方法 这是一项对接受 24 小时 ABPM 的患者的回顾性研究。使用 MAP 与收缩压/舒张压的动态 HTN 诊断的一致性水平使用 Cohen 的 kappa 系数进行评估。对身高超过 165 厘米的男性使用成人与儿科标准进行了类似的分析以评估 HTN 诊断的一致性。结果 共纳入 263 项 ABPM 研究。使用 MAP 或收缩压/舒张压对 HTN 的诊断有很好的一致性（k = 0.75；95% CI：0.67-0.83）。然而，在 12% (n = 31) 的受试者中，这些方法之间存在分歧。同样，儿科和成人 HTN 诊断标准之间也有很好的一致性（k = 0.70；95% CI：0.56-0.85）。19 名患者被发现患有高血压（9 名使用 MAP 标准，10 名使用成人标准），他们不符合使用当前儿科指南的动态 HTN 标准。结论 将 MAP 与收缩压和舒张压一起纳入 ABPM 分析，并使用成人标准诊断身高 ≥ 165 cm 的男童 HTN 可能会提高儿科 HTN 诊断的准确性并降低假阴性率。需要更大规模的研究来评估这些结果的临床有效性。图形概要。