Use of Automated Office Blood Pressure Measurement in the Evaluation of Elevated Blood Pressures in Children and Adolescents

Objectives To determine the level of agreement between automated office blood pressures (AOBP), auscultated or manual office BP (manual office blood pressure), and 24-hour ABPM, and to explore the ability of AOBP and manual office blood pressure to correctly identify daytime ambulatory hypertension in children. Study design We retrospectively compared BPs obtained by AOBP and manual office blood pressure to predict daytime hypertension on ABPM. Six BPs were taken by AOBP followed by manual office blood pressure. Office hypertension was defined by BPs >= 95th percentile for sex and height percentiles for those <13 years of age and a BP of >= 130/80 mm Hg for ages >= 13 years. Daytime ambulatory hypertension was diagnosed if mean wake BPs were >= 95th percentile and BP loads were >= 25%. Application of adult ABPM thresholds for daytime hypertension (130/80 mm Hg) was assessed in ages >= 13 years. Sensitivity and specificity were calculated considering ABPM as the reference. Results Complete data were available for 187 patient encounters. Overall, the best agreement was found if both AOBP and manual office blood pressure showed hypertension, but owing to low sensitivity up to 49% of children with hypertension would be misclassified. The use of adult thresholds for ABPM did not improve agreement. Conclusions Neither AOBP nor manual office blood pressure confirm or exclude daytime ambulatory hypertension with confidence. These results suggest an ongoing role for ABPM in evaluation of hypertension in children.