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| Ambulatory pressure measurement |
Blood pressure ( BP ) measurement in children and adolescent can present can unique challenge to the clinician as interaction among the child, parent and clinician may induce errors in blood pressure measurement. the 1987 Working Group guidelines for blood measurement in children and adolescents outline the correct technique for accurate blood pressure measurement and where not changed in the most recent report in 2004. It should be noted that the 1987 Report of the Working Group on Blood Pressure Measurement in Children and adolescents in volved two important changes in blood pressure measurement. First it changed the definition of diastolic blood presure from use of phase 4 Korotkoff sounds to the use of phase 5 as is done in blood pressure measurement in adults. Secondly, this report also expanded the normative tables for blood pressure from the previous report to in corporate the impact height on normal values for blood pressure measurement. De Man et al. have shown that these normative values for European children are different than those for American children. Pooling information from six European studies ( Germany, France, Denmark and the Netherlands ) showed that the 95th precentile for men blood pressure was higher by 6 mm hg for systolic blood pressure ( SBP ) and 3 mm hg for diastolic BP ( DBP ) in both girl and boy. Menghetti and colleagues found the normal values for blood pressure for itlaian children differed from both the american data and also from the man's. Italian Children, with respect to the American standarts for the 90th and 95th percentiles were 3-8 mm hg higher for systolic and diastolic blood pressure in both sexes betwen 5 and 12 yearsof age and 2-3 mm hg higher in older males. Unique to the pediatric hypertension, diag nosis of hypertension requires both accurate blood pressure mesaurement and knowledge of the normal values of blod pressure in the population the clinicia is caring for.
Accurate blood pressure determination remains elusive in clinic practice. Unfortunately, it has been demonstrated that primary care physician or nurse rarely conform to the guidelines when measuring blood pressure in clinical practice. This may be due to failure to train these observers adequately as was noted by Grim and Grim as well as underemphasis of the importance of accurate blood pressure measurement in the literature. failure to follow the guidelines regarding patient positioning , such as sitting with back supported and feet on the floor, arm supported at heart level, appropriate size cuff applied, and use the mean of two or more blood pressure measurement, for the diagnosis of hypertension, can induce significant errors in blood measurement.
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