Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research

American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX75231-4596, USA.
Hypertension (Impact Factor: 6.48). 10/2008; 52(3):433-51. DOI: 10.1161/HYPERTENSIONAHA.108.190329
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Available from: Laura L Hayman, Jan 05, 2014
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    • "Additionally, systolic blood pressure load (SBPL) and diastolic (DBPL) blood pressure load during the day and night was calculated. HT on the basis of ABPM was defined as mean systolic BP levels that are ≥95th percentile and LSBP more than 25 % [20]. Data analysis was performed using the computer program Statistica 10.0 PL (StatSoft, Tulsa, USA). "
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    ABSTRACT: The prevalence of hypertension continues to rise in the pediatric population. In recent years, there has been an increasing amount of reports on serum arginine vasopressin and its derivative, copeptin, in blood pressure control, but its role is still unclear. The objective of this study was to assess serum copeptin in adolescents with essential hypertension. The study cohort consisted of 84 subjects (30 girls and 54 boys) aged 11-18 years, divided into two groups: hypertension (HT) - 53 subjects with confirmed primary hypertension and R - reference group - 31 subjects in whom hypertension was excluded on the basis of ambulatory blood pressure monitoring (ABPM) (white-coat hypertension). Serum copeptin concentration was measured using a commercially available enzyme-linked immunosorbent assay kit (USCN). Hypertensive patients had higher serum copeptin levels (median, 267 [Q1-Q3: 151.1-499.7 pg/ml]) than controls (median, 107.3 [Q1-Q3: 36.7-203.4 pg/ml]), (p < 0.01). Statistically significant difference was found both in males and females. In both groups, positive correlations between serum copeptin and uric acid levels (r = 0.31, p < 0.01), albuminuria (r = 0.45, p < 0.01), serum triglycerides (r = 0.3, p < 0.05), body mass index (BMI) standard deviation score (SDS) (r = 0.24, p < 0.05) and 24-h systolic blood pressure (SBP) (r = 0.37, p < 0.01) and diastolic blood pressure (DBP) (r = 0.23, p < 0.05) were found. In summary, higher serum copeptin levels, a surrogate for arginine vasopressin (AVP) release, are associated not only with systolic and diastolic blood pressure but also with several components of metabolic syndrome including obesity, elevated concentration of triglycerides, albuminuria, and serum uric acid level. However, for the time being, more research is needed in order to confirm the role of serum copeptin as a novel marker of elevated blood pressure and predictor of metabolic syndrome.
    Pediatric Nephrology 12/2013; 29(3). DOI:10.1007/s00467-013-2683-5 · 2.86 Impact Factor
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    • "Age- and gender-based normal criteria [22] were used to find abnormal daytime, nighttime and 24-hour blood pressure definitions for normal systolic and diastolic blood pressure, subjects greater than 16 years of age were measured against adult references [23]. The presence of pre-hypertension and hypertension was determined on clinic and ambulatory blood pressure levels in association with systolic blood pressure load (percentage of systolic blood pressure readings above the 95th centile for gender and age) using standard definitions [22]. The BP dip was measured as mean daytime systolic blood pressure – mean nighttime blood pressure/mean daytime blood pressure x 100, with normal considered to be greater than 10%. "
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    ABSTRACT: The detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes. Patients aged between 8 – 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher’s exact and t-tests determined the association with clinical findings. 26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy. This pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes. Trial registration Clinical Trial number NCT01279928,
    BMC Endocrine Disorders 10/2013; 13(1):41. DOI:10.1186/1472-6823-13-41 · 1.71 Impact Factor
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    • "The Welch Allyn ABPM 6100 monitor was used in all cases with set parameters according to reference values provided by Wuhl et al. [8]. ABPM tests' results were interpreted according to Urbina et al. [9]. Systolic or diastolic loads defined as the percent of readings above the 95th percentile were considered abnormal if greater than 25% [9]. "
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    ABSTRACT: Childhood hypertension's increasing prevalence has generally been linked to the obesity epidemic. We observed that a significant proportion of children referred to our pediatric center with documented office hypertension are nonobese and have a history of attention deficit hyperactivity disorder (ADHD). To define the extent of this anecdotal observation, we performed a retrospective analysis of ambulatory blood pressure monitoring (ABPM) tests which in our center are routinely performed in newly referred children suspected of hypertension. Twenty-one percent (48 of 227 new referrals) had a history of ADHD, and 81% of them were treated with psychostimulant medications at the time of their ABPM test. Children in this group had a significantly lower average BMI z-score compared with the rest of the children (0.18 versus 0.75) and were significantly more likely to have abnormally elevated wake systolic loads on ABPM (38% versus 4%). The overall proportion of children with any abnormality on ABPM was comparable in both groups (46% versus 40%). Conclusion. A significant proportion of children suspected of hypertension have ADHD which may be related to higher wake systolic BP values. The prevalence of hypertension among children with ADHD will have to be determined in prospective studies.
    International Journal of Hypertension 07/2013; 2013:419208. DOI:10.1155/2013/419208
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