Percentiles for boys (n = 347)
Percentiles for girls
(n = 420)
Height (cm)
N
50th
95th
N
50th
95th
120–129
23
105/64
119/76
36
101/64
119/74
130–139
51
108/64
121/77
51
103/64
120/76
140–149
39
110/65
125/77
61
105/65
122/77
150–159
41
112/65
126/78
71
108/66
123/77
160–169
45
115/65
128/78
148
110/66
124/78
170–179
91
117/66
132/78
46
112/66
125/79
180–189
57
121/67
134/79
7
114/67
128/80
Instructions for home blood pressure monitoring in children and adolescents (permission from [5])
Devices |
• Use automated electronic (oscillometric) upper-arm devices that have been successfully validated specifically in children |
• Ensure the appropriate cuff size for the individual’s arm circumference is utilized |
• Select devices equipped with automated memory or PC link capacity when available |
Conditions |
• Measurements may be taken by parents of young children, or self-measurements may be appropriate for some adolescents |
• Perform measurements in a quiet room after 5 min of rest in the seated position with back supported and arm resting at heart level |
Schedule |
• Monitor home blood pressure for no less than 3 routine school days but preferably 6–7 days |
• Obtain duplicate morning and evening measurements (with 1 min intervals) on each day BP is monitored |
Interpretation |
• Calculate the average of all measurements after discarding the first day |
• Evaluate the average value using the available normalcy data for home blood pressure in children |
• Average home blood pressure ≥95th percentile for gender and height indicates home hypertension |
In conclusion, home BP monitoring in children appears to be superior to office BP due to several advantages, including the detection of white-coat and masked hypertension, lack of observer error and bias, and higher reproducibility. However, since the current evidence for ambulatory BP monitoring in children is much stronger, this method should have the primary role in diagnosis, with home BP monitoring being used if ambulatory monitoring is not available or not tolerated. Data on the optimal home BP monitoring schedule, and normalcy tables with thresholds (percentiles) for home hypertension diagnosis are now available but the evidence on the relationship with preclinical target-organ damage and validation of electronic home monitors in children is limited. Accumulating data will probably allow home BP monitoring to acquire an evidence-based role in wide clinical application in children and adolescents in near future.
13.2 Home Blood Pressure Monitoring in Pregnancy
Measuring BP in pregnancy has unique importance and its own specific challenges [18]. It is fundamental to both detecting and managing hypertension in pregnancy, which can have acute implications for both mother and baby. Hypertension maybe a sign of preeclampsia, a leading cause of maternal mortality (14%) and preterm birth (20%) globally [19]. Preeclampsia, characterized by hypertension, is often asymptomatic, even if severe, and BP measurement is the hallmark of identification. One-quarter of all stillbirths and neonatal deaths are attributed to this disease in low and middle income countries. If left unrecognized, life-threatening disease invariably ensues, usually within 2 weeks. Measuring BP will identify those who need monitoring and delivery, and indicate those who require therapy to reduce the risk of cerebrovascular events. When correctly managed, preeclampsia deaths are largely avoidable [20]. The implications of over or missed diagnosis are substantial and therefore correct BP measurement is key to safe management.
BP should be measured at every antenatal visit. However, even antenatal schedules may not be sufficiently frequent to identify fulminant preeclampsia where onset and progress can be rapid and often asymptomatic. The potential for home monitoring to assist in identification and management is therefore substantial.
Care in technique and correct cuff size is similar to all patients, but specifically aortocaval compression should be avoided when lying supine in the third trimester by left lateral tilt. Sitting is an appropriate instruction for those using home monitors. Korotkoff fifth sound should be used for auscultation in determining diastolic BP [21] if used in clinic to compare with home assessment to elucidate white-coat effects. The vasodilatation of pregnancy does not alter the accuracy of the fifth Korotkoff sound, and home BP devices should be validated to this diastolic endpoint. Digit preference is common among midwives at initial assessment and threshold avoidance must be avoided given the possible severe implications of even mild hypertension in pregnancy. Home monitoring helps eliminate these errors.
Devices validated in pregnancy
Manufacturer | Device model |
|---|---|
Omron | MITa, MIT Elitea, Hem 705CPa, M7a |
Microlife | Watch BP Homea, BP 3BTO-Aa, BP 3AS1-2a, Cradle VSAa |
Welch Allyn | Spot Vital Sign |
Dinamap | ProCare 400 |
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