Ambulatory blood pressure monitoring (ABPM) is considered the best way to diagnose hypertension in children. What is ABPM and how does it help find and treat high blood pressure in children?

Story by: Kim Huston on June 29, 2021

Ambulatory blood pressure monitoring (ABPM) is considered the best way to diagnose and monitor hypertension in children.

Hypertension, also called persistent high blood pressure on repeat checks, is rising among children and teens due to many factors, including obesity and lifestyle changes. High blood pressure as a child may lead to an increased risk of developing heart conditions earlier in adulthood. What is ABPM, and how does it help find and treat hypertension in children?

What is ambulatory blood pressure monitoring?

ABPM uses a special device where a blood pressure cuff is worn on the arm and attached to a small recording device that a child can wear 24 hours a day. While the child wears the device, blood pressure is recorded at 15-minute intervals during the daytime and 30-minute intervals at night. Children are encouraged to continue their normal activities when the device is on, and parents are recommended to keep a log of their activities.

Ambulatory means walking or movable, a reference to the child going on with regular daily routines while the device records blood pressure readings. According to American Academy of Pediatrics (AAP) guidelines, 24-hour blood pressure (BP) monitoring is considered the best way to diagnose and treat high blood pressure in children. Norton Children’s Nephrology, affiliated with the UofL School of Medicine, offers ambulatory blood pressure monitoring via its pediatric hypertension program.

Why use ABPM for hypertension?

The AAP recommends screening for hypertension  annually in children starting at age 3 by clinic blood pressure measurements. In addition, BP monitoring should be done at every clinic visit among children with a high risk of hypertension irrespective of age, including among neonates and infants. The AAP also recommends using ABPM to confirm the diagnosis of hypertension in children and teens. According to the AAP standards, ABPM is helpful to:

• Confirm the diagnosis of hypertension.
• Differentiate so-called “white coat hypertension” (higher blood pressure readings when taken at a doctor’s office due to feeling anxious or nervous) apart from true hypertension.
• Determine the type of hypertension (moderate versus severe).
• Evaluate how well medication and lifestyle changes are working to control your child’s blood pressure.

If your child has a blood pressure reading that may suggest pre-hypertension or stage 1 hypertension, your child’s pediatrician likely will ask you to follow up in a few weeks or up to about six months. From there, the provider will continue to monitor your child and may suggest you see a pediatric nephrologist for ABPM. Norton Children’s Nephrology, affiliated with the UofL School of Medicine, has the most extensive ABPM program in Louisville and Southern Indiana.

“A single high blood pressure reading does not mean a child has hypertension,” said Siddharth A. Shah, M.D., a pediatric nephrologist with Norton Children’s Nephrology and medical director of the pediatric hypertension program. “ABPM gives a well-rounded look at your child’s blood pressure at different times of day and night in a 24 hour period that helps us diagnose and manage hypertension and create a supportive plan of action to help lower your child’s blood pressure. In addition, we take a family-based approach including an individualized dietary plan and set realistic goals and expectations towards these lifestyle changes for optimal blood pressure control.”