Home blood pressure monitoring in children and adolescents: a systematic review.

OBJECTIVE

As in the adults, in children and adolescents with elevated blood pressure (BP), the conventional office BP measurements might lead to incorrect diagnosis. Therefore, out-of-office BP measurements are often needed. Several studies have demonstrated the value of ambulatory BP (ABP) monitoring in pediatric hypertension, whereas home BP (HBP) monitoring has only recently been evaluated.

METHODS

A systematic review of the evidence on HBP monitoring in children and adolescents has been performed (Medline/PubMed, Embase and Cochrane Library).

RESULTS

A total of 27 studies (19 original study reports, two surveys, three guidelines documents, two reviews and one letter) were identified. These data suggest that by using electronic arm devices, reliable HBP readings are obtained. Unfortunately, very few electronic devices have been successfully validated in children. The reproducibility of HBP in children appears to be superior to office and similar to ABP measurements. Three-day-HBP monitoring with duplicate morning and evening measurements is the minimum schedule required, yet 6-7-day monitoring is recommended. HBP in children and adolescents is lower than daytime ABP, whereas no such difference exists in the adults. A school-based study in 778 children and adolescents provided the first HBP normalcy data. HBP has similar diagnostic value in children as in the adults and appears to be a reliable alternative to ABP monitoring in the detection of white-coat hypertension.

CONCLUSION

HBP monitoring appears to have considerable potential in pediatric hypertension. More research is needed on the clinical application of this method in children and adolescents.