A Vote of Confidence for Clinic-Based Blood Pressure Testing

Published March 7, 2018 | Clinical Journal of the American Society of Nephrology

Safe to say, no child or parent is enthusiastic about 24-hour ambulatory blood pressure monitoring (ABPM). But despite the inconvenience and expense associated with ABPM devices, they have long been considered the gold standard for accuracy.

That is essential when treating children with chronic kidney disease (CKD).

However, new research shows that for children with CKD, protocol-driven manual blood pressure (BP) testing in the clinic may be just as accurate as ABPM, and just as effective in predicting associated organ damage (progression to end-stage kidney disease or left ventricular hypertrophy).

The research is part of the Chronic Kidney Disease in Children (CKiD) study, a National Institutes of Health-funded prospective cohort study of more than 900 children with mild to moderate impaired kidney function.

To compare BP testing methods, all 50 CKiD sites used the same equipment and methodology to measure 513 children during a research visit.

“We showed that clinic BP was on par with ABMP for this patient population,” says Mark Mitsnefes, MD, MS, a pediatric nephrologist and co-principal investigator. “This is good news, because ABPM devices are cumbersome, uncomfortable to wear and expensive—not every clinic can afford one.

“Now,” he says, “we can be confident that clinic BP measurements are a safe and effective alternative for kids with CKD, as long as providers use the study’s precise protocols.”

These findings are limited to the care of children with CKD, but Mitsnefes hopes it inspires other researchers to compare the two BP testing methods in other patient populations.