Clin Hypertens.  2022;28(1):34. 10.1186/s40885-022-00217-2.

Ambulatory hypertension diagnosed by 24‑h mean ambulatory versus day and night ambulatory blood pressure thresholds in children: a cross‑sectional study

• Sharma A
• Altamirano‑Diaz L
• Mohamed Ali M
• Stronks K
• Kirpalani A
• Filler G
• Norozi K

• KMID: 2535137
• DOI: http://doi.org/10.1186/s40885-022-00217-2

Abstract

Background
The agreement between the commonly used ambulatory blood pressure (ABP) thresholds to diag‑ nose ambulatory hypertension in children (patient’s 24-h mean ABP classified by 24-h 95th ABP percentile threshold, American Heart Association [AHA] threshold, or patient’s day and night mean ABP classified by day-night 95th ABP percentile thresholds) is not known. We evaluated the agreement among 24-h ABP threshold, AHA threshold, and day-night ABP thresholds to diagnose ambulatory hypertension, white coat hypertension (WCH) and masked hyper‑ tension (MH).
Methods
In a cross-sectional study design, we analyzed ABP recordings from 450 participants with suspected hypertension from a tertiary care outpatient hypertension clinic. The American Academy of Pediatrics thresholds were used to diagnose office hypertension.
Results
The 24-h ABP threshold and day-night ABP thresholds classified 19% ABP (95% confidence interval [CI], 0.15– 0.23) differently into ambulatory normotension/hypertension (kappa [κ], 0.58; 95% CI, 0.51–0.66). Ambulatory hyper‑ tension diagnosed by 24-h ABP threshold in 27% participants (95% CI, 0.22–0.32) was significantly lower than that by day-night ABP thresholds in 44% participants (95% CI, 0.37–0.50; P < 0.001). The AHA threshold had a stronger agree‑ ment with 24-h ABP threshold than with day-night ABP thresholds for classifying ABP into ambulatory normotension/ hypertension (k 0.94, 95% CI 0.91–0.98 vs. k 0.59, 95% CI 0.52–0.66). The diagnosis of ambulatory hypertension by the AHA threshold (26%; 95% CI, 0.21–0.31) was closer to that by 24-h ABP threshold (27%, P = 0.73) than by day-night ABP thresholds (44%, P < 0.001). Similar agreement pattern persisted among these ABP thresholds for diagnosing WCH and MH.
Conclusions
The 24-h ABP threshold classifies a lower proportion of ABP as ambulatory hypertension than daynight ABP thresholds. The AHA threshold exhibits a stronger agreement with 24-h ABP than with day-night ABP thresholds for diagnosing ambulatory hypertension, WCH and MH. Our findings are relevant for a consistent interpre‑ tation of hypertension by these ABP thresholds in clinical practice.

Keyword

Pediatrics; Blood Pressure; Hypertension; White coat hypertension; Masked hypertension; Ambulatory Blood Pressure Monitoring