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Variation in paediatric 24-h ambulatory blood pressure monitoring interpretation by Canadian and UK physicians

Journal of Human Hypertension volume 37, pages 363–369 (2023)Cite this article

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A Correction to this article was published on 11 July 2022

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Abstract

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is widely accepted as a more accurate method for measurement of blood pressure (BP) compared to a single office-based measurement of BP. However, it is unclear how physicians interpret ABPM and make management decisions. This study’s goal is to investigate variation in ABPM interpretation among paediatric nephrologists (Canada and UK) and paediatric cardiologists (Canada only) via an online survey. The survey content included baseline demographics, questions on the use and indications for ABPM, interpretation of results, and subsequent management decisions in various clinical scenarios. The survey was sent to 196 Canadian physicians, with 69 (35.2%) total responses. Thirty-five UK clinicians also completed the survey. Most respondents were >44 years old, were in practice for at least 11 years, and were university-based. There were substantial differences among clinicians in ABPM interpretation for isolated systolic, diastolic, and night-time hypertension. For example, only 53.1% of physicians would initiate or modify treatment in those with diastolic HTN in CKD. Further, even for the same abnormal ABPM parameter, the decision to start or alter treatment was influenced by the underlying medical condition. There is significant variation in clinical practice among physicians for interpretation and management of hypertension when using ABPM. Differences in guidelines among various jurisdictions, as well as knowledge gaps in the research on which guidelines are based, create ambiguity regarding ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasoning behind the variation in physicians’ interpretation may help to standardise practice.

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Fig. 1: ABPM cut-off values to diagnose hypertension in children by nephrologists (from Canada and UK) and cardiologists (from Canada only). (N = 81).
Fig. 2: Canadian paediatric nephrologists’ alteration to treatment by ABPM parameter and underlying diagnosis. (N = 26).
Fig. 3: Canadian paediatric cardiologists’ alteration to treatment by ABPM parameter and underlying diagnosis. (N = 20).

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All data generated and analysed during this study are included in this published article and its corresponding supplementary information files.

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Acknowledgements

We would like to acknowledge all physicians who responded to our survey from UK and Canada.

Author information

Author notes

  1. These authors contributed equally: Janis Dionne, Rahul Chanchlani.

Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Isabella Z. Stefanova

  2. Division of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Manish D. Sinha & Douglas J. Stewart

  3. Division of Paediatric Nephrology, McMaster University, Hamilton, Ontario, Canada

    Abdulaziz Bamhraz & Rahul Chanchlani

  4. Division of Paediatric Cardiology, University of Montreal, Montreal, Quebec, Canada

    Anne Fournier

  5. Division of Paediatric Cardiology, BC Children’s Hospital, Vancouver, British Columbia, Canada

    Kevin C. Harris

  6. Division of Paediatric Nephrology, Western University, London, Ontario, Canada

    Guido Filler

  7. Division of Paediatric Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Damien Noone & Chia Wei Teoh

  8. Division of Paediatric Nephrology, BC Children’s Hospital, Vancouver, British Columbia, Canada

    Janis Dionne

  9. Population Health Research Institute, ICES, McMaster University, Hamilton, Ontario, Canada

    Rahul Chanchlani

  10. Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

    Rahul Chanchlani

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Contributions

All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; and provided final approval of the version to be published.

Corresponding author

Correspondence to Rahul Chanchlani.

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The authors declare no competing interests.

Ethics approval

Ethics approval was acquired from the Hamilton Integrated Research Ethics Board (HiREB; project number 11383). The requirement for survey respondent consent was waived, as completion of the survey would confirm the respondents’ consent.

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The original online version of this article was revised: Due to an error in the corresponding authorship.

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Stefanova, I.Z., Sinha, M.D., Stewart, D.J. et al. Variation in paediatric 24-h ambulatory blood pressure monitoring interpretation by Canadian and UK physicians. J Hum Hypertens 37, 363–369 (2023). https://doi.org/10.1038/s41371-022-00702-z

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