TABLE 13

Recommended Procedures for the Application of ABPM

ProcedureRecommendation
DeviceShould be validated by the Association for the Advancement of Medical Instrumentation or the British Hypertension Society for use in children
May be oscillometric or auscultatory
ApplicationTrained personnel should apply the monitor
Correct cuff size should be selected
Right and left arm and a lower extremity BP should be obtained to rule out coarctation of the aorta
Use nondominant arm unless there is large difference in size between the left arm and right arm, then apply to the arm with the higher BP
Take readings every 15–20 min during the day and every 20–30 min at night
Compare (calibrate) the device to resting BP measured by the same technique (oscillometric or auscultatory)
Record time of medications, activity, and sleep
AssessmentA physician who is familiar with pediatric ABPM should interpret the results
Interpret only recordings of adequate quality. Minimum of 1 reading per hour, 40–50 for a full day, 65%–75% of all possible recordings
Edit outliers by inspecting for biologic plausibility, edit out calibration measures
Calculate mean BP, BP load (% of readings above threshold), and dipping (% decline in BP from wake to sleep)
Interpret with pediatric ABPM normal data by sex and height
Use AHA staging schema155
Consider interpretation of 24-h, daytime, and nighttime MAP, especially in patients with CKD173,198
  • Adapted from Flynn JT, Daniels SR, Hayman LL, et al; American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63(5):1116–1135.