Clin Hypertens.  2022;28(1):34. 10.1186/s40885-022-00217-2.

Ambulatory hypertension diagnosed by 24‑h mean ambulatory versus day and night ambulatory blood pressure thresholds in children: a cross‑sectional study

Affiliations
  • 1Division of Nephrology, Department of Paediatrics, University of Western Ontario, London, ON, Canada
  • 2London Health Sciences Centre, London, ON, Canada
  • 3Division of Cardiology, Department of Paediatrics, University of Western Ontario, London, ON, Canada
  • 4University of Western Ontario, London, ON, Canada
  • 5Department of Paediatric Cardiology and Intensive Care, Medical School Hannover, Hannover, Germany

Abstract

Background
The agreement between the commonly used ambulatory blood pressure (ABP) thresholds to diag‑ nose ambulatory hypertension in children (patient’s 24-h mean ABP classified by 24-h 95th ABP percentile threshold, American Heart Association [AHA] threshold, or patient’s day and night mean ABP classified by day-night 95th ABP percentile thresholds) is not known. We evaluated the agreement among 24-h ABP threshold, AHA threshold, and day-night ABP thresholds to diagnose ambulatory hypertension, white coat hypertension (WCH) and masked hyper‑ tension (MH).
Methods
In a cross-sectional study design, we analyzed ABP recordings from 450 participants with suspected hypertension from a tertiary care outpatient hypertension clinic. The American Academy of Pediatrics thresholds were used to diagnose office hypertension.
Results
The 24-h ABP threshold and day-night ABP thresholds classified 19% ABP (95% confidence interval [CI], 0.15– 0.23) differently into ambulatory normotension/hypertension (kappa [κ], 0.58; 95% CI, 0.51–0.66). Ambulatory hyper‑ tension diagnosed by 24-h ABP threshold in 27% participants (95% CI, 0.22–0.32) was significantly lower than that by day-night ABP thresholds in 44% participants (95% CI, 0.37–0.50; P < 0.001). The AHA threshold had a stronger agree‑ ment with 24-h ABP threshold than with day-night ABP thresholds for classifying ABP into ambulatory normotension/ hypertension (k 0.94, 95% CI 0.91–0.98 vs. k 0.59, 95% CI 0.52–0.66). The diagnosis of ambulatory hypertension by the AHA threshold (26%; 95% CI, 0.21–0.31) was closer to that by 24-h ABP threshold (27%, P = 0.73) than by day-night ABP thresholds (44%, P < 0.001). Similar agreement pattern persisted among these ABP thresholds for diagnosing WCH and MH.
Conclusions
The 24-h ABP threshold classifies a lower proportion of ABP as ambulatory hypertension than daynight ABP thresholds. The AHA threshold exhibits a stronger agreement with 24-h ABP than with day-night ABP thresholds for diagnosing ambulatory hypertension, WCH and MH. Our findings are relevant for a consistent interpre‑ tation of hypertension by these ABP thresholds in clinical practice.

Keyword

Pediatrics; Blood Pressure; Hypertension; White coat hypertension; Masked hypertension; Ambulatory Blood Pressure Monitoring
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