Reproducibility of Office and Out-of-Office Blood Pressure Measurements in Children: Implications for Clinical Practice and Research
Open accessAbstract
This study aimed to evaluate the reproducibility of office (OBP), ambulatory (ABP), and home blood pressure (HBP) measurements in children and adolescents, and their implications in diagnosing hypertension in clinical practice and in pediatric hypertension research. Apparently healthy children and adolescents referred for suspected hypertension were included. Measurements of 2-visit OBP, 7-day HBP, and 24-hour ABP were performed twice, 1 to 6 months apart. Reproducibility was quantified using the SD of differences between repeated measurements. The sample size of clinical trials comparing the efficacy of antihypertensive drugs using each method was calculated. Fifty-eight individuals were analyzed (mean age, 13.0±2.9 years, 60.3% boys). The reproducibility of 24-hour ABP (SD of differences 5.7/4.5 systolic/diastolic) and HBP (5.9/5.0 mm Hg) were comparable and superior to that of visit-2 OBP (9.2/7.8) and awake (6.7/5.5) or asleep ABP (7.6/6.1). As a consequence, a parallel-group comparative trial aiming to detect a difference in the effect of 2 drugs of 10 mm Hg systolic BP, would require 36 participants when using OBP measurements, 14 using 24-hour ABP, and 15 using HBP (102/34/42 respectively for detecting a 5 mm Hg difference in diastolic BP). For a crossover design trial, the corresponding sample sizes are 9/3/4 for systolic BP and 26/9/11 for diastolic, respectively. These data suggest that in children and adolescents 24-hour ABP and 7-day HBP have similar reproducibility, superior to OBP and daytime or asleep ABP. These findings have major implications in diagnosing hypertension in children in clinical practice and in designing clinical research trials in pediatric hypertension.
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Some studies suggest that HBPM has better reproducibility than ambulatory blood pressure monitoring.
“with some studies suggesting a better reproducibility of HBPM than ambulatory BP monitoring (ABPM) [20,21].”
HBPM and ABPM are similar but not identical methods, and the diagnostic agreement between them is sometimes a challenging clinical issue.
“Thus, HBPM and ABPM are similar but are not identical methods and the diagnostic agreement between them is sometimes a challenging clinical issue [20]”
The reproducibility of BP information provided by HBPM and ABPM was shown to be similar by direct comparison in the same individuals, or even higher for HBPM.
“An important issue to consider is the reproducibility of BP information provided by HBPM and ABPM, respectively, which was shown to be similar by a direct comparison of HBPM and ABPM data in the same individuals [18,170], or even higher for HBPM [20]”
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“and standard deviation of differences between repeated home and ambulatory BP measurements suggests a similar reproducibility of the two methods, and a better reproducibility of both as compared with OBP [18,19], with some studies suggesting a better reproducibility of HBPM than ambulatory BP monitoring (ABPM) [20,21].”
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“05 in a parallel-group design clinical trial [26,27].”
BackgroundNocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort
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“73 m(2), n5500 51 (23) 51 (22) 50 (25) Creatine-cystatin C–based eGFR 53 (20) 53 (20) 53 (21) Casual BP, n5535 Normal BP 348 (65) 199 (63) 149 (68) Elevated BP 71 (13) 45 (14) 26 (12) Stage 1 hypertension 92 (17) 57 (18) 35 (16) Stage 2 hypertension 24 (5) 14 (5) 10 (4) Nocturnal hypertension 283 (51) 131 (40) 152 (68…”
BackgroundNocturnal Dipping and Kidney Function Decline: Findings From the CKD in Children Study
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“…been accumulated on the additionalvalue ofout-of-office BPmeasurements(i.e.home or ambulatory BP monitoring) for epidemiological, clinical and decision-making purposes in the setting of hypertension hyperten-sion-mediated organ damage (HMOD) and incident cardio-vascular disease and mortality [3–5].”
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“Great care was taken for the assessment of office BP status in accordance with the recommendations of the American Heart Association [47].”
MethodInsights From Matched Office and Ambulatory Blood Pressure in Youth: Clinical Relevance
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“The aims of our study were: (1) to analyze the characteristics of ABP in T1D children, (2) to establish if there is an association between ABP parameters including BPV and different levels of albuminuria, and (3) to identify potential predictors of highnormal albuminuria and microalbuminuria in T1D children.”
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“Home BP in children is important for both the precise diagnosis, and monitoring of hypertension control, but depends on accurate BP measurements [12,18].”
BackgroundMethodResultInfluentialAccuracy of Home Blood Pressure Monitoring in Youth: A Systematic Review and Meta-Analysis
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Methodology and Applicability of Home Blood Pressure Monitoring in Children and Adolescents
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Stergiou, G. S., & Ntineri, A. (2022) · Springer eBooks · doi:10.1007/978-3-319-31420-4_45-2
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- Authors
- Stergiou, G. S., Bountzona, I., Alamara, C., Vazeou, A., Kollias, A., & Ntineri, A.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
- ORCID
- Venue
- Hypertension
- Published
- 2021-03-03
- Volume
- 77
- Issue
- 3
- Pages
- 993-1000
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W3120509859
- Cited by
- 31
- References
- 33
- Citations by year
- 2026: 4 · 2025: 7 · 2023: 5 · 2022: 9 · 2021: 6
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- office blood pressure, ambulatory blood pressure monitoring, home blood pressure monitoring, pediatric hypertension, children and adolescents, 24-hour ambulatory blood pressure, sample size determination, antihypertensive drug trials, hypertension diagnosis
- MeSH terms
- Adolescent, Blood Pressure, Blood Pressure Determination, Child, Cross-Sectional Studies, Diastole, Female, Humans, Hypertension, Male, Office Visits, Systole, Reproducibility of Results, Blood Pressure Monitoring, Ambulatory
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