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LETTER TO EDITOR
Year : 2013  |  Volume : 23  |  Issue : 6  |  Page : 463-464
 

Prospective analysis of utility and feasibility of ambulatory blood pressure monitoring service in a pediatric nephrology set up


Department of Paediatric Nephrology, AMRI Group of Hospitals and Paediatric Medicine, Institute of Child Health, Kolkata, West Bengal, India

Date of Web Publication24-Oct-2013

Correspondence Address:
R Sinha
37, G Bondel Road, Kolkata - 700 019, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.120349

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How to cite this article:
Sinha R. Prospective analysis of utility and feasibility of ambulatory blood pressure monitoring service in a pediatric nephrology set up. Indian J Nephrol 2013;23:463-4

How to cite this URL:
Sinha R. Prospective analysis of utility and feasibility of ambulatory blood pressure monitoring service in a pediatric nephrology set up. Indian J Nephrol [serial online] 2013 [cited 2022 Jan 28];23:463-4. Available from: https://www.indianjnephrol.org/text.asp?2013/23/6/463/120349


Sir,

Despite ambulatory blood pressure monitoring (ABPM) becoming standard of care in adult practice [1] as well as its strong recommendation in pediatric hypertension (HT) guidelines [2],[3] there are very few reports on its utility and feasibility in children from emerging economy and none from Indian subcontinent. [4] We hereby present a prospective analysis of an ABPM service initiated in February 2012. Pediatric ABPM service was initiated with Welch Allyn 6100 monitor using appropriate blood pressure (BP) cuff sizes. It was offered to all children above 5 years of age with incidental (without any obvious underlying reason for HT) clinic blood pressure (CBP) persistently ≥95 th percentile (p) but ≤99 th p +5 mm Hg or as a standard of care for children with chronic kidney disease (CKD) (≥stage 3), post renal transplant (RTx), solitary kidney, renal scar, and post-op for coarctation of the aorta. The American Heart Association (AHA) recommendation [2] was taken as standard and ABPM limits were set accordingly. Height was used for estimating the ABPM limits or age if height was less than 120 cm. [2],[3] Interpretation was as per AHA suggestions-normal: (CBP < 95 th p, mean ABPM < 95 th p and systolic load (SL) <25%), white coat hypertension (WCH): (CBP > 95 th p, mean ABPM < 95 th p and SL < 25%), masked hypertension (MH): (CBP < 95 th p, mean ABPM > 95 th and SL < 25%), pre-HT: (CBP > 95 th p, mean ABPM < 95 th p and SL > 25% but < 50%), ambulatory hypertension (AH): (CBP > 95 th p, mean ABPM > 95 th p and SL > 25%, but < 50%) and severe AH: (CBP < 95 th p, mean ABPM < 95 th p and SL > 50%). Until 31 st March 2013; 69 children had ABPM (26% female) with the median age of 9.2 years (range 5-18). As per the AHA recommendation all of them had at least one reading per hour and the total number of readings were greater than 40 (median number of total reading was 52 with range 41-72). Sleep diary was used to ascertain day and night time. Underlying reason for undertaking ABPM and the outcome are shown in [Figure 1]. Incidental HT was the most common underlying reason. WCH was found in 27% (n = 19) of the total subjects and MH in 4% (n = 3). On analysis of utility; ABPM resulted in definite change in management in 36% of the cases (n = 25). Whereas WCH was detected in 19 children MH was detected in three cases (all three cases were of CKD including one post RTx). In addition, anti-hypertensive medications were increased in another three cases of known hypertensive wherein ABPM showed severe ambulatory HT although CBP was only around 95 th percentile. In conclusion, similar to western literature [2] we also found a high incidence of WCH (27%) as well as MH (21% among CKD and RTx). Diagnosis of WCH does avoid further costly investigation as well as use of anti-hypertensive medications, [5] whereas diagnosis of MH can result in more effective control of BP, which is likely to result in improved renal outcome. Although small in numbers, our study supports the use of pediatric ABPM even in Indian circumstances and should encourage its increased utilization.
Figure 1: Outcomes of the ambulatory blood pressure monitoring. ABPM = ambulatory blood pressure monitoring, CKD = Chronic Kidney Disease, Co - arc = co-arctation, HT = hypertension, MH= masked hypertension, Misc = miscellaneous, Tx = Renal transplant

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  References Top

1.http://www.guidance.nice.org.uk/CG127/QuickRefGuide/pdf/English. [Last accessed on 2013 Apr 15].  Back to cited text no. 1
    
2.Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, et al. Ambulatory blood pressure monitoring in children and adolescents: Recommendations for standard assessment: A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 2008;52:433-51.  Back to cited text no. 2
    
3.Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, et al. Management of high blood pressure in children and adolescents: Recommendations of the European Society of Hypertension. J Hypertens 2009;27:1719-42.  Back to cited text no. 3
    
4.Furusawa ÉA, Filho UD, Junior DM, Koch VH. Home and ambulatory blood pressure to identify white coat and masked hypertension in the pediatric patient. Am J Hypertens 2011;24:893-7.  Back to cited text no. 4
    
5.Swartz SJ, Srivaths PR, Croix B, Feig DI. Cost-effectiveness of ambulatory blood pressure monitoring in the initial evaluation of hypertension in children. Pediatrics 2008;122:1177-81.  Back to cited text no. 5
    


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Indian Journal of Nephrology
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