Practical application of ABPM in the pediatric nephrology clinic
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EDUCATIONAL REVIEW
Practical application of ABPM in the pediatric nephrology clinic Susan Halbach 1 Received: 29 March 2019 / Revised: 7 August 2019 / Accepted: 6 September 2019 # IPNA 2019
Abstract The use of 24-h ABPM has become commonplace when diagnosing and managing hypertension in the pediatric population. Multiple clinical guidelines recommend ABPM as the preferred method for identifying white-coat hypertension, masked hypertension, and determining degree of blood pressure (BP) control. Accurate, timely diagnosis and optimal management are particularly important in certain populations, such as children with chronic kidney disease (CKD), diabetes, and other conditions with increased risk for cardiovascular disease. Understanding how best to utilize ABPM to achieve these goals is important for pediatric nephrologists and other hypertension specialists. This review will provide practical information on the equipment, application, interpretation, and documentation of ABPM in the specialty clinic. Keywords Blood pressure . Hypertension . Ambulatory blood pressure monitoring . Child
Introduction Recognizing and treating hypertension in the pediatric population is an important aspect of managing early manifestations of cardiovascular disease. Although ambulatory blood pressure monitoring (ABPM) has been available and utilized in the adult population for several decades, it has not been widely used in pediatric patients until relatively recently. Current adult clinical guidelines almost universally recommend ABPM as the standard method for diagnosing hypertension and its use in managing hypertension continues to expand [1, 2]. When compared to office BPs, parameters available through ABPM are more predictive of adverse cardiovascular and cerebrovascular events in adults [3–5]. ABPM data have helped further our understanding of the contribution of BP patterns, in particular the importance of nocturnal and masked hypertension, to disease severity and outcomes [6, 3]. The use of ABPM in pediatrics has demonstrated that the associations between ABPM patterns and target organ effects are not confined to the adult population, particularly in children with chronic kidney disease (CKD) [7–10]. * Susan Halbach [email protected] 1
Division of Nephrology, Seattle Children’s Hospital; Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, M/S OC.9.820, Seattle, WA 98105, USA
In examining the practical application of ABPM in the pediatric population, specifically those children referred for specialty care in the pediatric nephrology clinic, this review will discuss the following: (1) the methodology and interpretation of ABPM in children and adolescents, (2) the use of ABPM parameters to diagnose hypertension, (3) the suggested use of ABPM for management of hypertension in children, and (4) the cost-effectiveness of ABPM with respect to other strategies for identifying hypertension. As most children with suspected hypertension are seen by pediatric nephrologists, fami
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