Oscillometric casual blood pressure normative standards for Swedish children using ABPM to exclude casual hypertension.
BACKGROUND
Casual blood pressure (CBP) is considered a reliable proxy for cardiovascular health. Although the auscultatory technique is the reference standard method for measuring CBP, oscillometric devices are increasingly being used in children. We sought to establish oscillometric CBP normative standards for Swedish children.


METHODS
Cross-sectional oscillometric CBP readings were obtained by the Welch Allyn Spot Vital Signs 420 monitor and measured according to the International Guidelines' recommendations. Participants with elevated oscillometric CBP levels underwent verification by the auscultatory method. Ambulatory blood pressure monitoring (ABPM) was used to exclude casual hypertension. Data on 1,470 (772 males) apparently healthy Swedish schoolchildren aged 6-16 years were analyzed and sex-specific reference charts normalized to age or height were constructed.


RESULTS
Systolic and diastolic CBP values were significantly higher with age, height, height standard deviation score (SDS), body mass index (BMI), and BMI SDS. Gender differences for systolic CBP were present starting from age of 15 years and revealed significantly higher values in boys than in girls, whereas for diastolic CBP, the differences were apparent at the age of 12 years, with higher values in girls. Increased BMI and BMI SDS were positively associated with CBP levels. Positive parental history of hypertension turned out to be a risk factor for higher systolic and diastolic CBP across all ages.


CONCLUSIONS
Our normative standard for CBP can be used for blood pressure screening and control programs in Swedish children. The use of ABPM should be considered to confirm the diagnosis of casual hypertension.
Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden;
Rafael T
RT
Krmar
Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden;
Ulla
U
Holtbäck
Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden;
Anita
A
Bergh
Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden;
Eva
E
Svensson
Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
Elke
E
Wühl
D000293:Adolescent; D000367:Age Factors; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D009991:Oscillometry; D011237:Predictive Value of Tests; D012015:Reference Standards; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology
ambulatory blood pressure monitoring; blood pressure; casual blood pressure; hypertension; oscillometric device; pediatrics; reference values.