Recommended Procedures for the Application of ABPM
| Procedure . | Recommendation . |
|---|---|
| Device | Should be validated by the Association for the Advancement of Medical Instrumentation or the British Hypertension Society for use in children |
| May be oscillometric or auscultatory | |
| Application | Trained personnel should apply the monitor |
| Correct cuff size should be selected | |
| Right and left arm and a lower extremity BP should be obtained to rule out coarctation of the aorta | |
| Use nondominant arm unless there is large difference in size between the left arm and right arm, then apply to the arm with the higher BP | |
| Take readings every 15–20 min during the day and every 20–30 min at night | |
| Compare (calibrate) the device to resting BP measured by the same technique (oscillometric or auscultatory) | |
| Record time of medications, activity, and sleep | |
| Assessment | A physician who is familiar with pediatric ABPM should interpret the results |
| Interpret only recordings of adequate quality. Minimum of 1 reading per hour, 40–50 for a full day, 65%–75% of all possible recordings | |
| Edit outliers by inspecting for biologic plausibility, edit out calibration measures | |
| Calculate mean BP, BP load (% of readings above threshold), and dipping (% decline in BP from wake to sleep) | |
| Interpret with pediatric ABPM normal data by sex and height | |
| Use AHA staging schema155 | |
| Consider interpretation of 24-h, daytime, and nighttime MAP, especially in patients with CKD173,198 |
| Procedure . | Recommendation . |
|---|---|
| Device | Should be validated by the Association for the Advancement of Medical Instrumentation or the British Hypertension Society for use in children |
| May be oscillometric or auscultatory | |
| Application | Trained personnel should apply the monitor |
| Correct cuff size should be selected | |
| Right and left arm and a lower extremity BP should be obtained to rule out coarctation of the aorta | |
| Use nondominant arm unless there is large difference in size between the left arm and right arm, then apply to the arm with the higher BP | |
| Take readings every 15–20 min during the day and every 20–30 min at night | |
| Compare (calibrate) the device to resting BP measured by the same technique (oscillometric or auscultatory) | |
| Record time of medications, activity, and sleep | |
| Assessment | A physician who is familiar with pediatric ABPM should interpret the results |
| Interpret only recordings of adequate quality. Minimum of 1 reading per hour, 40–50 for a full day, 65%–75% of all possible recordings | |
| Edit outliers by inspecting for biologic plausibility, edit out calibration measures | |
| Calculate mean BP, BP load (% of readings above threshold), and dipping (% decline in BP from wake to sleep) | |
| Interpret with pediatric ABPM normal data by sex and height | |
| Use AHA staging schema155 | |
| Consider interpretation of 24-h, daytime, and nighttime MAP, especially in patients with CKD173,198 |
Adapted from Flynn JT, Daniels SR, Hayman LL, et al; American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63(5):1116–1135.