Elsevier

The Journal of Pediatrics

Volume 130, Issue 2, February 1997, Pages 178-184
The Journal of Pediatrics

Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: A multicenter trial including 1141 subjects,☆☆,,★★

https://doi.org/10.1016/S0022-3476(97)70340-8Get rights and content

Abstract

Ambulatory blood pressure (ABP) monitoring is increasingly used to evaluate the blood pressure of children and adolescents. The upper normal ABP values in the pediatric age group are still unknown, because reference values based on a sufficiently high number of healthy children have not yet been published. In this multicenter trial, we pooled ABP records of 1141 healthy children and adolescents with a body height between 115 and 185 cm. The study was carried out by seven centers according to a common protocol. The 50th percentile for 24-hour systolic ABP increased moderately with height, from 103 to 113 mm Hg in girls and from 105 to 120 mm Hg in boys. The 50th percentile for diastolic 24-hour means was 66 ± 1 mm Hg, irrespective of height or gender. Diastolic daytime means were 73 ± 1 mm Hg, which is remarkably high compared with reference values for casual blood pressure. The mean nocturnal systolic and diastolic ABP (midnight to 6 am ) was 13% ± 6% and 23% ± 9% lower compared with the daytime means (8 am to 8 pm ), respectively. This multicenter study provides well-based limits of normal ABP in mid-European children. (J Pediatr 1997;130:178-84)

Section snippets

Subject population

Twelve hundred fifty-four white children and adolescents (639 girls and 615 boys) participated in the study. Variables such as age, gender, and height were recorded. Medical histories and medication use were obtained with a questionnaire. Children were included only if they were healthy, with no history of diseases known to affect blood pressure, and if they were not taking any medication. Thirteen subjects (all girls) were excluded for incomplete readings, 23 (15 girls, 8 boys) for belonging

Mean values

The systolic means showed a slight but significant increase with body height for any period (more pronounced in boys than in girls). All diastolic means were independent of height or gender. The 24-hour means stayed at 4 to 8 mm Hg less than daytime means for systolic ABP and at 6 to 9 mm Hg less than daytime means for diastolic ABP. The smallest children showed the largest difference between ABP daytime means and 24-hour means.

The interindividual variation of ABP was low, resulting in

DISCUSSION

ABP monitoring has become a useful element in the evaluation and follow-up of hypertension in adults. Despite excellent concordance for single measurements, the ABP mean values for healthy children have been shown to differ significantly from their CBP values. 12, 19 Pediatric reference values for ABP thus are mandatory for adequate interpretation. Reference values describe a population sample expected to be representative with respect to the parameter evaluated. The subjects in this study,

Acknowledgements

We are indebted to Prof. Karl Schärer for the initiation of the study and stimulating discussions.

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    From the University Children's Hospital, Marburg, Germany; University Children's Hospital, Lübeck, Germany; Institute of Medical Statistics, Hamburg, Germany; University Children's Hospital of the Virchow-Klinikum, Berlin, Germany; University Children's Hospital of the Charité, Berlin, Germany; University Children's Hospital, Ulm, Germany; Children's Hospital of the Medizinische Hochschule, Hannover, Germany; Pediatric Cardiology of the University of Saarland, Homburg/Saar, Germany; the First Department of Pediatrics, Semmelweis University Medical School, Budapest, Hungary; and University Children's Hospital, Giessen, Germany

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    Supported by the German Institute of High Blood Pressure Research, Heidelberg, Germany (Dr. Busch), and by the Hungarian Medical Scientific Council (grant ETT: T-06 380/93) (Dr. Reusz).

    Reprint requests: Marianne Soergel, MD University Children's Hospital, Deutschhausstrasse 12, D—35033 Marburg, Germany.

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