Department of Pediatrics, Seattle Children's Hospital, Seattle, WA.
Seattle Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA.
J Pediatr. 2020 Dec;227:204-211.e6. doi: 10.1016/j.jpeds.2020.06.059. Epub 2020 Jul 4.
To determine the level of agreement between automated office blood pressures (AOBP), auscultated or manual office BP (manual office blood pressure), and 24-hour ABPM, and to explore the ability of AOBP and manual office blood pressure to correctly identify daytime ambulatory hypertension in children.
We retrospectively compared BPs obtained by AOBP and manual office blood pressure to predict daytime hypertension on ABPM. Six BPs were taken by AOBP followed by manual office blood pressure. Office hypertension was defined by BPs ≥95th percentile for sex and height percentiles for those <13 years of age and a BP of ≥130/80 mm Hg for ages ≥13 years. Daytime ambulatory hypertension was diagnosed if mean wake BPs were ≥95th percentile and BP loads were ≥25%. Application of adult ABPM thresholds for daytime hypertension (130/80 mm Hg) was assessed in ages ≥13 years. Sensitivity and specificity were calculated considering ABPM as the reference.
Complete data were available for 187 patient encounters. Overall, the best agreement was found if both AOBP and manual office blood pressure showed hypertension, but owing to low sensitivity up to 49% of children with hypertension would be misclassified. The use of adult thresholds for ABPM did not improve agreement.
Neither AOBP nor manual office blood pressure confirm or exclude daytime ambulatory hypertension with confidence. These results suggest an ongoing role for ABPM in evaluation of hypertension in children.
确定自动诊室血压（AOBP）、听诊或手动诊室血压（手动诊室血压）与 24 小时 ABPM 的一致性水平，并探讨 AOBP 和手动诊室血压正确识别儿童日间动态高血压的能力。
我们回顾性比较了 AOBP 和手动诊室血压测量值，以预测 ABPM 上的日间高血压。AOBP 测量 6 次血压，然后测量手动诊室血压。诊室高血压定义为<13 岁者按性别和身高百分位第 95 百分位定义，≥13 岁者血压≥130/80mmHg。如果平均清醒血压≥95 百分位且血压负荷≥25%，则诊断为日间动态高血压。评估≥13 岁者日间高血压（130/80mmHg）时采用成人 ABPM 阈值。考虑到 ABPM 作为参考，计算了敏感性和特异性。
187 例患者的完整数据可用。总体而言，如果 AOBP 和手动诊室血压均显示高血压，则一致性最佳，但由于敏感性低，高达 49%的高血压儿童会被误诊。使用成人 ABPM 阈值并不能提高一致性。
AOBP 和手动诊室血压均不能可靠地确认或排除日间动态高血压。这些结果表明 ABPM 在儿童高血压评估中仍具有重要作用。
