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Use of Automated Office Blood Pressure Measurement in the Evaluation of Elevated Blood Pressures in Children and Adolescents.

OBJECTIVES: To determine the level of agreement between AOBP, auscultated or manual office BP (MOBP) and 24 hour ABPM, and to explore the ability of AOBP and MOBP to correctly identify daytime ambulatory hypertension (HTN) in children.

STUDY DESIGN: We retrospectively compared BPs obtained by AOBP and MOBP to predict daytime HTN on ABPM. Six BPs were taken by AOBP followed by MOBP. Office HTN was defined by BPs > 95th % for sex and height percentiles for those < 13 and >130/80 for ages > 13 years. Daytime ambulatory HTN was diagnosed if mean wake BPs were > 95th percentile and BP loads were >25%. Application of adult ABPM thresholds for daytime HTN (130/80) was assessed in ages > 13 years. Sensitivity and specificity were calculated considering ABPM as the reference.

RESULTS: Complete data were available for 187 patient encounters. Overall, best agreement was found if both AOBP and MOBP showed HTN but due to low sensitivity up to 49% of children with HTN would be misclassified. Use of adult thresholds for ABPM did not improve agreement.

CONCLUSIONS: Neither AOBP nor MOBP confirm or exclude daytime ambulatory HTN with confidence. These results suggest an ongoing role for ABPM in evaluation of HTN in children.

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