Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring

OBJECTIVE: To investigate the usefulness of home blood pressure measurements in comparison with ambulatory monitoring in the diagnosis of sustained, white-coat hypertension and masked hypertension in children and adolescents. SUBJECTS AND METHODS: One hundred and two subjects, referred for elevated blood pressure, were assessed with clinic (two visits), home (6 days) and awake ambulatory blood pressure measurements [64 boys, mean age 12.8 +/- 2.9 (SD) years, range 6-18 years]. RESULTS: Office hypertension was diagnosed in 38 subjects, ambulatory hypertension in 31 and home hypertension in 23 (P = 0.07). On the basis of clinic and ambulatory blood pressure, 52% of subjects were normotensive, 20% hypertensive, 18% had white-coat hypertension and 11% masked hypertension, whereas on the basis of clinic and home blood pressure, 55, 15, 23 and 8%, respectively. There was an agreement between ambulatory and home blood pressure in the diagnosis of hypertension in 82 cases (80%). When a 5-mmHg gray zone of diagnostic uncertainty was applied above and below the diagnostic thresholds, there were only eight cases with clinically important disagreement. By taking ambulatory blood pressure as the reference method for the diagnosis of hypertension, the sensitivity, specificity and positive and negative predictive values of home blood pressure were 55, 92, 74 and 82%, respectively, for the diagnosis of white-coat hypertension 89, 92, 70 and 98%, respectively, and for masked hypertension 36, 96, 50 and 93%, respectively. CONCLUSION: In children and adolescents, there is a reasonable agreement between home and ambulatory blood pressure measurements as diagnostic methods in hypertension. Home blood pressure appears to be a useful diagnostic test in this population, particularly for the detection of white-coat hypertension.