title: Usefulness of ambulatory blood pressure monitoring and head-up tilt test in the evaluation of paediatric syncope.
abstract: OBJECTIVE
  The aim of this study was to investigate the usefulness of ambulatory blood pressure monitoring versus head-up tilt test in the evaluation of children with a history of syncope.
  
  
  METHODS
  We considered 146 consecutive children with more than one episode of syncope. All patients had a normal electrocardiogram at rest and were otherwise considered to be healthy. Forty-six patients,19 male, with a mean age of 13.6 plus or minus 5.6 years, were studied with a head-up tilt test and 100 patients, 41 male with a mean age of 9.4 plus or minus 5.6 years, were studied with ambulatory blood pressure monitoring. Twelve patients underwent both procedures. Hypotension during ambulatory blood pressure monitoring was defined when mean blood pressure values were lower than the 50th centile and the head-up tilt test was positive when syncope occurred. All patients were followed for 10 plus or minus 2 months.
  
  
  RESULTS
  Ambulatory blood pressure monitoring showed postural hypotension in 91% children, while head-up tilt test was positive for 54%. In the group of children having both tests, two of them were negative for both, 10 of 12 children had a positive ambulatory blood pressure monitoring while only five of 10 children had a positive response to head-up tilt test.
  
  
  CONCLUSIONS
  When a child with a normal resting electrocardiogram is referred with a typical history of syncope, the use of ambulatory blood pressure monitoring as a non-invasive first step for diagnosis of postural hypotension may be more sensitive than the head-up tilt test. Behavioural adjustments resolved the continued syncope in most cases. If episodes persist then the head-up tilt test is indicated.
authors.affiliation: Cardiology and Cardiac Surgery Department, Cardiorespiratory and Sport Medicine Unit, Bambino Gesù Children's Hospital - Research Institute, Rome, Italy. giordano@opbg.net
authors.forename: Ugo
authors.initials: U
authors.lastname: Giordano
authors.forename: Roberta
authors.initials: R
authors.lastname: Meta
authors.forename: Danilo
authors.initials: D
authors.lastname: Fintini
authors.forename: Attilio
authors.initials: A
authors.lastname: Turchetta
authors.forename: Claudia
authors.initials: C
authors.lastname: Brufani
authors.forename: Armando
authors.initials: A
authors.lastname: Calzolari
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis* / Q000503:physiopathology