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Updates to Pediatric Ambulatory Blood Pressure Monitoring in Clinical Practice: a Review and Strategies for Expanding Access

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Abstract

Purpose of Review

To discuss blood pressure classification using ambulatory blood pressure monitoring (ABPM) according to the new American Heart Association 2022 pediatric ABPM guidelines, ABPM evidence and epidemiology of hypertension disorders, and the potential role of ABPM in primary care.

Recent Findings

Pediatric hypertension remains underdiagnosed with an increasing prevalence worldwide. Clinic blood pressure is widely used to screen for and diagnose hypertension but has limitations such as inability to detect white coat effect, nocturnal blood pressure patterns, or masked hypertension. ABPM is the gold standard for diagnosing hypertension disorders in youth as well as adults, yet its adoption remains low.

Summary

Widespread use of ABPM could improve gaps that currently exist in the screening, diagnosis, and care of youth with hypertension disorders in an efficient and cost-effective way. While ABPM access is often limited to pediatric sub-specialist clinics with limited geographical reach, improved access to this important tool could be supported by lowering barriers to its use by primary care providers and others in the community. As a community that provides care for youth with hypertension and those at risk for hypertension disorders, we strive to increase local access to ABPM devices, advocate for reliable reimbursement for the procedure, and promote educational programs for clinicians interested in providing ABPM with the goal of earlier and more accurate diagnoses of hypertension to improve short- and long-term outcomes among children.

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Funding

AMS reports funding from National Institute of Health-National Heart, Lung, and Blood Institute (NIH-NHLBI): K23HL148394, L40HL148910, and R01HL146818. RC reports funding from Canadian Institute of Health Research (CIHR), Kidney Foundation of Canada, and Hamilton Health Sciences.

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Author notes

  1. Jennifer E. Butler and Carol Vincent are the co-first authors.

  2. Rahul Chanchlani and Andrew M. South are the co-senior authors.

Authors and Affiliations

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

    Jennifer E. Butler

  2. Section of Nephrology, Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA

    Carol Vincent & Andrew M. South

  3. Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, 1280 Main St W, Hamilton, ON, L8N 3Z5, Canada

    Rahul Chanchlani

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  1. Jennifer E. Butler
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Butler, J.E., Vincent, C., South, A.M. et al. Updates to Pediatric Ambulatory Blood Pressure Monitoring in Clinical Practice: a Review and Strategies for Expanding Access. Curr Pediatr Rep 10, 172–181 (2022). https://doi.org/10.1007/s40124-022-00273-0

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