Introduction - Obtaining reliable blood pressure (BP) values in children may be challenging. Neither office blood pressure measurement (OBPM), as recommended by current guidelines, nor 24-hour ambulatory blood pressure monitoring (ABPM) fully addresses these issues. Since 2005, the Centre for Haemolytic Uremic Syndrome in Milan (Italy) has routinely employed multiple Office Blood Pressure Monitoring (mOBPM).
Objective - BP as measured with mOBPM was compared with the standard approach suggested by guidelines.
Materials and methods - A cohort of healthy children underwent two mOBPM assessments one year apart. Mean systolic and diastolic BP values obtained by mOBPM were compared with the 1st, 2nd, 3rd and 4th measurements (repeated-measures ANOVA). mOBPM recordings with a coefficient of variation (CV) >15% were excluded. The number of children with BP >90th percentile was determined by considering: a) each of the first three readings, b) the mean of the 2nd and 3rd measurements, c) the 4th measurement, d) the mOBPM at baseline and e) one year apart.
Results - 13 children out of the 164 enrolled were excluded due to a CV >15% in either systolic or diastolic BP values. In the remaining 151 children, the first three measurements were significantly higher than the mOBPM values, whereas the 4th measurement was the first that did not significantly differ from mOBPM. Based on the 1st, 2nd, 3rd and 4th readings, a BP >90th percentile was observed in 29, 20, 21 and 16 children, respectively. The mean of the 2nd and 3rd readings identified 12 children with elevated BP, while the mOBPM revealed abnormal BP in only 6 children, of whom only 3 had confirmed values >90th percentile one year later.
Conclusions - The first three measurements systematically overestimate BP, while the 4th one better aligns with the mOBPM. If the 4th reading is abnormal, a complete mOBPM will likely provide a more reliable assessment of BP.