title: Should mean arterial pressure be included in the definition of ambulatory hypertension in children?
abstract: BACKGROUND
  The diagnosis of hypertension (HTN)/normotension (NT) on ambulatory blood pressure monitoring (ABPM) is usually based on systolic (SBP) or diastolic blood pressure (DBP). The goal of this study was to analyze whether inclusion of mean arterial pressure (MAP) improves the detection of HTN on ABPM.
  
  
  METHODS
  We retrospectively studied ABPM records in 229 children (116 boys, median age = 15.3 years) who were referred for evaluation of HTN. A diagnosis of HTN was made if: (A) MAP or SBP or DBP was ≥ 1.65 SDS (95th percentile); (B) SBP or DBP was ≥ 1.65 SDS (95th percentile), during 24-h or daytime or night-time in both definitions.
  
  
  RESULTS
  Using definition A, 46/229 patients had HTN compared to definition B by which only 37/229 patients had HTN (p = 0.001). The level of agreement between the two definitions was very good (kappa = 0.86 ± 0.04), however nine patients (19.5 %) were missed by not using MAP in the definition of HTN. These nine patients had only mild HTN with a median Z score of 1.69.
  
  
  CONCLUSIONS
  The inclusion of MAP in the definition of ambulatory HTN significantly increased the number of hypertensive patients. MAP may be very helpful in detecting mild HTN in patients with normal/borderline SBP and DBP.
authors: Department of Pediatrics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic. terezie.sulakova@fno.cz
authors: Terezie
authors: T
authors: Suláková
authors: Janusz
authors: J
authors: Feber
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D062186:Arterial Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013599:Systole; D009626:Terminology as Topic; D013997:Time Factors