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J Am Soc Hypertens. 2015 Oct;9(10):780-784. doi: 10.1016/j.jash.2015.07.016. Epub 2015 Aug 3.

Impact of ambulatory blood pressure monitoring on the diagnosis of hypertension in children.

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Pediatric Department, Pediatric Nephrology Unit, Sapienza University of Rome, Rome, Italy. Electronic address:
Pediatric Department, Pediatric Nephrology Unit, Sapienza University of Rome, Rome, Italy.
Pediatric Operative Unit, Policlinico-Vittorio-Emanuele University Hospital, Catania, Italy.
DiBiC-Biomedical and Clinic Science Department, "Luigi Sacco" University of Milan, Milan, Italy.


Screening of hypertension in children commonly starts with office measurement of the blood pressure according to the Fourth Report. The latter however does not account for masked hypertension (MH) on the one hand and white coat hypertension (WCH) on the other. We aimed to investigate in a single large pediatric population how much the addition of ambulatory blood pressure monitoring (ABPM) helps to refine the allocation to the different classes of blood pressure. In a retrospective study, we reclassified the records of a cohort of 500 children, who attended our department for investigation of possible hypertension, according to the Fourth Report and the revised ABPM interpretation scheme. As expected, ABPM interpretation scheme detected MH and WCH; however, 14% of children evaluated according to this scheme did not fit in any categories. On the other hand, applying the Fourth Report criteria, 80% of prehypertensive children ended up in the uncategorized or the MH groups. Our data confirm that ABPM detects the cases of MH and WCH, and minimizes the misplacement of prehypertensive children; unfortunately however, it also leaves a significant number of patients remain unclassified.


Clinic blood pressure; masked hypertension; prehypertension; white coat hypertension

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