The Clinical Application of Ambulatory Blood Pressure Monitoring in Pediatrics

DOI: 10.4236/ijcm.2011.25111   PDF   HTML     4,284 Downloads   6,997 Views  


Management of hypertension (HTN) largely relies on proper and accurate measurement of blood pressure (BP). Even following the criteria for HTN diagnosis defined in the Fourth report on high BP in children and adolescents, inaccurate diagnosis and misdiagnosis can occur with white coat effect and masked HTN. The use of Ambulatory Blood Pressure Monitoring (ABPM) has been increasing in pediatrics in the last 20 years. The main use of ABPM is to differentiate between sustained HTN and white coat HTN in patients who have elevated casual BP measurements and to detect masked HTN in high risk patients. ABPM is most useful in patients with casual BP within 20% of the 95th percentile for age, gender, and height. This report will highlight the use of ABPM in the evaluation of elevated BP and management of HTN in pediatrics. The discussion includes a review of various non-invasive BP measuring techniques, a description of ABPM and ABPM-unique data and diagnoses, updated ABPM clinical data more specific to pediatrics, its use in HTN clinical trials, and future outlook and direction of ABPM in pediatrics.

Share and Cite:

Y. Miyashita, "The Clinical Application of Ambulatory Blood Pressure Monitoring in Pediatrics," International Journal of Clinical Medicine, Vol. 2 No. 5, 2011, pp. 650-660. doi: 10.4236/ijcm.2011.25111.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. J. Stewart and P. L. Padfield, “Measurement of Blood Pressure in the Technological Age,” British Medical Bulletin, Vol. 50, No. 2, 1994, pp. 420-442.
[2] R. J. Portman and R. J. Yetman, “Clinical Uses of Ambulatory Blood Pressure Monitoring,” Pediatric Nephrology, Vol. 8, No. 3, 1994, pp. 367-376. doi:10.1007/BF00866367
[3] T. Mengden, M. R. M. Hernandez, B. Beltran, E. Alvarez, K. Kraft and H. Vetter, “Reliability of Reporting Self- Measured Blood Pressure Values by Hypertensive Patients,” American Journal of Hypertension, Vol. 11, No. 12, 1998, pp. 1413-1417. doi:10.1016/S0895-7061(98)00241-6
[4] T. G. Wells, W. A. Neaville, J. R. Arnold and C. W. Belsha, “Evaluation of Home Blood Pressure Monitors in Children and Adolescents,” American Journal of the Medical Sciences, Vol. 315, No. 2, 1998, pp. 110-117. doi:10.1097/00000441-199802000-00007
[5] American Academy of Pediatrics, “The 4th Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,” Pediatrics, Vol. 114, No. 2, 2004, pp. 555-576. doi:10.1542/peds.114.2.S2.555
[6] J. T. Flynn, “Impact of Ambulatory Blood Pressure Monitoring on the Management of Hypertension in Children,” Blood Pressure Monitor, Vol. 5, No. 4, 2000, pp. 211-216. doi:10.1097/00126097-200008000-00003
[7] L. Butani and B. Z. Morgenstern, “Are pitfalls of Oxcillometric Blood Pressure Measurements Preventable in Children?” Pediatric Nephrology, Vol. 18, No. 4, 2003, pp. 313-318.
[8] M. K. Park, S. W. Menard and C. Yuan, “Comparison of Auscultatory and Oscillometric Blood Pressures,” Archives of Pediatrics & Adolescent Medicine, Vol. 155, No. 1, 2001, pp. 50-53.
[9] E. Urbina, B. Alpert, J. Flynn, L. Hayman, G. A. Harsh-field, M. Jacobson, et al., “Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment: A Scientific Statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research,” Hypertension, Vol. 52, No. 3, 2008, pp. 433-451. doi:10.1161/HYPERTENSIONAHA.108.190329
[10] M. Soergel, M. Kirschstein, C. Busch, T. Danne, J. Gellermann, R. Holl, et al., “Oscillometric Twenty-Four-Hour Ambulatory Blood Pressure Values in Healthy Children and Adolescents: A Multicenter Trial Including 1141 Subjects,” Journal of Pediatrics, Vol. 130, No. 2, 1997, pp. 178-184. doi:10.1016/S0022-3476(97)70340-8
[11] E. Wuhl, K. Witte, M. Soergel, O. Mehls and F. Schaefer, “Distribution of 24-h Ambulatory Blood Pressure in Children: Normalized Reference Values and Role of Body Dimensions,” Journal of Hypertension, Vol. 20, No. 10, 2002, pp. 1995-2007. doi:10.1097/00004872-200210000-00019
[12] D. K. Wilson, D. A. Sica and S. B. Miller, “Ambulatory Blood Pressure Nondipping Status in Salt-Sensitive and Salt-Resistant Black Adolescents,” American Journal of Hypertension, Vol. 12, No. 2, 1999, pp. 159-165. doi:10.1016/S0895-7061(98)00234-9
[13] G. A. Harshfield, P. Barbeau, P. A. Richey and B. S. Alpert, “Racial Differences in the Influence of Body Size on Ambulatory Blood Pressure in Youths,” Blood Pressure Monitor, Vol. 5, No. 2, 2000, pp. 59-63.
[14] S. Koshy, C. Macarthur, S. Luthra, M. Gajaria and D. Geary, “Ambulatory Blood Pressure Monitoring: Mean Blood Pressure and Blood Pressure Load,” Pediatric Nephrology, Vol. 20, No. 10, 2005, pp. 1484-1486. doi:10.1007/s00467-005-2014-6
[15] R. Lubrano, E. Travasso, C. Raggi, G. Guido, R. Masciangelo and M. Elli, “Blood Pressure Load, Proteinuria and Renal Function in Pre-Hypertensive Children,” Pediatric Nephrology, Vol. 24, No. 4, 2009, pp. 823-831. doi:10.1007/s00467-008-1077-6
[16] E. Lurbe, J. M. Sorof and S. R. Daniels, “Clinical and Research Aspects of Ambulatory Blood Pressure Monitoring in Children,” Journal of Pediatrics, Vol. 144, No. 1, 2004, pp. 7-16. doi:10.1016/j.jpeds.2003.09.050
[17] J. M. Sorof, G. Cardwell, K. Franco and R. J. Portman, “Ambulatory Blood Pressure and Left Ventricular Mass Index in Hypertensive Children,” Hypertension, Vol. 39, No. 4, 2002, pp. 903-908. doi:10.1161/01.HYP.0000013266.40320.3B
[18] G. S. Stergiou, N. J. Yiannes, V. C. Rarra and C. V. Alamara, “White-Coat Hypertension and Masked Hypertension in Children,” Blood Pressure Monitor, Vol. 10, No. 6, 2005, pp. 297-300. doi:10.1097/00126097-200512000-00002
[19] J. M. Sorof, T. Poffenbarger, K. Franco and R. Portman, “Evaluation of White Coat Hypertension in Children: Importance of the Definitions of Normal Ambulatory Blood Pressure and the Severity of Casual Hypertension,” American Journal of Hypertension, Vol. 14, No. 9, 2001, pp. 855-860. doi:10.1016/S0895-7061(01)02180-X
[20] E. Lurbe, I. Torro, V. Alvarez, T. Nawrot, R. Paya, J. Redon, et al., “Prevalence, Persistence, and Clinical Significance of Masked Hypertension in Youth,” Hypertension, Vol. 45, No. 4, 2005, pp. 493-548. doi:10.1161/01.HYP.0000160320.39303.ab
[21] G. S. Stergiou, V. C. Rarra and N. G. Yiannes, “Prevalence and Predictors of Masked Hypertension Detected by Home Blood Pressure Monitoring in Children and Adolescents: The Arsakeion School Study,” American Journal of Hypertension, Vol. 22, No. 5, 2009, pp. 520-524. doi:10.1038/ajh.2009.34
[22] S. Stabouli, V. Kotsis, S. Toumanidis, C. Papamichael, A. Constantopoulos and N. Zakopoulos, “White-Coat and Masked Hypertension in Children: Association with Target- Organ Damage,” Pediatric Nephrology, Vol. 20, No. 8, 2005, pp. 1151-1155. doi:10.1007/s00467-005-1979-5
[23] Matsuoka S, Awazu M. Masked hypertension in children and young adults. Pediatric Nephrology, Vol. 19, No. 6, 2004, pp. 651-654. doi:10.1007/s00467-004-1459-3
[24] K. L. McNiece, M. Gupta-Malhotra, J. Samuels, C. Bell, K. Garcia, T. Poffenbarger, et al., “Left Ventricular Hypertrophy in Hypertensive Adolescents: Analysis of Risk by 2004 National High Blood Pressure Education Program Working Group Staging Criteria,” Hypertension, Vol. 50, No. 2, 2007, pp. 392-395. doi:10.1161/HYPERTENSIONAHA.107.092197
[25] G. Stergiou, A. Vazeou and C. Stefanidis, “American Heart Association’s Statement That ‘In Children Ambulatory Blood Pressure is Superior to Home’ Not Proven,” Hypertension, Vol. 52, No. 6, 2008, p. e145. doi:10.1161/HYPERTENSIONAHA.108.122309
[26] E. Wuhl, C. Hadtstein, O. Mehls and F. Schaefer, “Home, Clinic, and Ambulatory Blood Pressure Monitoring in Children with Chronic Renal Failure,” Pediatric Research, Vol. 55, No. 3, 2004, pp. 492-497. doi:10.1203/01.PDR.0000106863.90996.76
[27] J. A. Staessen, L. Beilin, G. Parati, B. Waeber and W. White, “Task Force IV: Clinical use of Ambulatory Blood Pressure Monitoring. Participants of the 1999 Consensus Conference on Ambulatory Blood Pressure Monitoring,” Blood Pressure Monitor, Vol. 4, No. 6, 1999, pp. 319-331. doi:10.1097/00126097-199900460-00005
[28] W. B. White, “Ambulatory Blood-Pressure Monitoring in Clinical Practice,” New England Journal of Medicine, Vol. 348, No. 24, 2003, pp. 2377-2378. doi:10.1056/NEJMp030057
[29] D. L. Clement, M. L. De Buyzere, D. A. De Bacquer, P. W. de Leeuw, D. A. Duprez, R. H. Fagard, et al., “Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension,” New England Journal of Medicine, Vol. 348, No. 24, 2003, pp. 2407-2415. doi:10.1056/NEJMoa022273
[30] T. Ohkubo, A. Hozawa, K. Nagai, M. Kikuya, I. Tsuji, S. Ito, et al., “Prediction of Stroke by Ambulatory Blood Pressure Monitoring versus Screening Blood Pressure Measurements in a General Population: The Ohasama Study,” Journal of Hypertension, Vol. 18, No. 7, 2000, pp. 847-854. doi:10.1097/00004872-200018070-00005
[31] P. Verdecchia, C. Porcellati, G. Schillaci, C. Borgioni, A. Ciucci, M. Battistelli, et al., “Ambulatory Blood Pressure. An Independent Predictor of Prognosis in Essential Hypertension,” Hypertension, Vol. 24, No. 6, 1994, pp. 793-801.
[32] M. J. Koren, R. B. Devereux, P. N. Casale, D. D. Savage and J. H. Laragh, “Relation of Left Ventricular Mass and Geometry to Morbidity and Mortality in Uncomplicated Essential Hypertension,” Annals of Internal Medicine, Vol. 114, No. 5, 1991, pp. 345-352.
[33] G. de Simone, R. B. Devereux, S. R. Daniels, M. J. Koren, R. A. Meyer and J. H. Laragh, “Effect of Growth on Variability of Left Ventricular Mass: Assessment of Allometric Signals in Adults and Children and Their Capacity to Predict Cardiovascular Risk,” Journal of the American College of Cardiology, Vol. 25, No. 5, 1995, pp. 1056-1062. doi:10.1016/0735-1097(94)00540-7
[34] D. Levy, R. J. Garrison, D. D. Savage, W. B. Kannel, W. P. Castelli, “Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study,” New England Journal of Medicine, Vol. 322, No. 22, 1990, pp. 1561-1566. doi:10.1056/NEJM199005313222203
[35] D. H. O’Leary, J. F. Polak, R. A. Kronmal, T. A. Manolio, G. L. Burke and S. K. Wolfson Jr., “Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults. Cardiovascular Health Study Collaborative Research Group,” New England Journal of Medicine, Vol. 340, No. 1, 1999, pp. 14-22. doi:10.1056/NEJM199901073400103
[36] T. W. Kamarck, D. E. Polk, K. Sutton-Tyrrell, M. F. Muldoon, “The Incremental Value of Ambulatory Blood Pressure Persists after Controlling for Methodological Confounds: Associations with Carotid Atherosclerosis in a Healthy Sample,” Journal of Hypertension, Vol. 20, No. 8, 2002, pp. 1535-1541. doi:10.1097/00004872-200208000-00016
[37] P. Verdecchia, F. Angeli, R. Gattobigio, C. Borgioni, C. Castellani, M. Sardone, et al., “The Clinical Significance of White-Coat and Masked Hypertension,” Blood Pressure Monitor, Vol. 12, No. 6, 2007, pp. 387-389. doi:10.1097/MBP.0b013e32824958e5
[38] F. Angeli, P. Verdecchia, R. Gattobigio, M. Sardone and G. Reboldi, “White-Coat Hypertension in Adults,” Blood Pressure Monitor, Vol. 10, No. 6, 2005, pp. 301-305. doi:10.1097/00126097-200512000-00003
[39] P. Verdecchia, G. P. Reboldi, F. Angeli, G. Schillaci, J. E. Schwartz, T. G. Pickering, et al., “Short- and Long-Term Incidence of Stroke in White-Coat Hypertension,” Hypertension, Vol. 45, No. 2, 2005, pp. 203-208. doi:10.1161/01.HYP.0000151623.49780.89
[40] L. R. Krakoff, “Cost-effectiveness of Ambulatory Blood Pressure: A Reanalysis,” Hypertension, Vol. 47, No. 1, 2006, pp. 29-34. doi:10.1161/01.HYP.0000197195.84725.66
[41] E. Lurbe, B. Cremades, C. Rodriguez, M. I. Torro, V. Alvarez and J. Redon, “Factors Related to Quality of Ambulatory Blood Pressure Monitoring in a Pediatric Population,” American Journal of Hypertension, Vol. 12, No. 9, 1999, pp. 929-933. doi:10.1016/S0895-7061(99)00076-X
[42] I. A. Khan, M. Gajaria, D. Stephens and J. W. Balfe, “Ambulatory Blood Pressure Monitoring in Children: A Large Center’s Experience,” Pediatric Nephrology, Vol. 14, No. 8-9, 2000, pp. 802-805. doi:10.1007/s004679900291
[43] J. M. Sorof, A. V. Alexandrov, G. Cardwell and R. J. Portman, “Carotid Artery Intimal-Medial Thickness and Left Ventricular Hypertrophy in children with Elevated Blood Pressure,” Pediatrics, Vol. 111, No. 1, 2003, pp. 61-66. doi:10.1542/peds.111.1.61
[44] S. R. Daniels, J. M. Loggie, P. Khoury and T. R. Kimball, “Left Ventricular Geometry and Severe Left Ventricular Hypertrophy in Children and Adolescents with Essential Hypertension,” Circulation, Vol. 97, No. 19, 1998, pp. 1907-1911.
[45] C. Hanevold, J. Waller, S. Daniels, R. Portman and J. Sorof, “The Effects of Obesity, Gender, and Ethnic Group on Left Ventricular Hypertrophy and Geometry in Hypertensive Children: A Collaborative Study of the Interna- tional Pediatric Hypertension Association,” Pediatrics, Vol. 113, No. 2, 2004, pp. 328-333. doi:10.1542/peds.113.2.328
[46] J. M. Sorof, J. Turner, D. S. Martin, K. Garcia, Z. Garami, A. V. Alexandrov, et al., “Cardiovascular Risk Factors and Sequelae in Hypertensive Children Identified by Referral versus School-Based Screening,” Hypertension, Vol. 43, No. 2, 2004, pp. 214-218. doi:10.1161/01.HYP.0000114696.96318.4e
[47] V. Kotsis, S. Stabouli, V. Pitiriga, C. Papamichael, S. Toumanidis and N. Zakopoulos, “Impact of Gender on 24-h Ambulatory Blood Pressure and Target Organ Damage,” Journal of Human Hypertension, Vol. 20, No. 9, 2006, pp. 658-665. doi:10.1038/sj.jhh.1002047
[48] V. Kotsis, S. Stabouli, V. Pitiriga, S. Toumanidis, C. Papamichael and N. Zakopoulos, “Ambulatory Blood Pressure Monitoring and Target Organ Damage: Effects of Age and Sex,” Blood Pressure Monitor, Vol. 11, No. 1, 2006, pp. 9-15. doi:10.1097/01.mbp.0000189785.59994.20
[49] M. Litwin, A. Niemirska, J. Sladowska, J. Antoniewicz, J. Daszkowska, A. Wierzbicka, et al., “Left Ventricular Hypertrophy and Arterial Wall Thickening in Children with Essential Hypertension,” Pediatric Nephrology, Vol. 21, No. 6, 2006, pp. 811-819. doi:10.1007/s00467-006-0068-8
[50] C. W. Belsha, T. G. Wells, K. L. McNiece, P. M. Seib, J. K. Plummer and P. L. Berry, “Influence of Diurnal Blood Pressure Variations on Target Organ Abnormalities in Adolescents with Mild Essential Hypertension,” American Journal of Hypertension, Vol. 11, No. 4, 1998, pp. 410-417. doi:10.1016/S0895-7061(98)00014-4
[51] S. Stabouli, V. Kotsis, C. Papamichael, A. Constantopoulos and N. Zakopoulos, “Adolescent Obesity is Associated with High Ambulatory Blood Pressure and Increased Carotid Intimal-Medial Thickness,” Journal of Pediatrics, Vol. 147, No. 5, 2005, pp. 651-656. doi:10.1016/j.jpeds.2005.06.008
[52] M. B. Lande, N. L. Carson, J. Roy and C. C. Meagher, “Effects of Childhood Primary Hypertension on Carotid Intima Media Thickness: A Matched Controlled Study,” Hypertension, Vol. 48, No. 1, 2006, pp. 40-44. doi:10.1161/01.HYP.0000227029.10536.e8
[53] M. B. Lande, H. Adams, B. Falkner, S. R. Waldstein, G. J. Schwartz, P. G. Szilagyi, et al., “Parental Assessments of Internalizing and Externalizing Behavior and Executive Function in Children with Primary Hypertension,” Journal of Pediatrics, Vol. 154, No. 2, 2009, pp. 207-212. doi:10.1016/j.jpeds.2008.08.017
[54] M. B. Lande, H. Adams, B. Falkner, S. R. Waldstein, G. J. Schwartz, P. G. Szilagyi, et al., “Parental Assessment of Executive Function and Internalizing and Externalizing Behavior in Primary Hypertension after Anti-Hypertensive Therapy,” Journal of Pediatrics, Vol. 157, No. 1, 2010, pp. 114-119. doi:10.1016/j.jpeds.2009.12.053
[55] H. R. Adams, P. G. Szilagyi, L. Gebhardt and M. B. Lande, “Learning and Attention Problems among Children with Pediatric Primary Hypertension,” Pediatrics, Vol. 126, No. 6, 2010, pp. e1425-e1429. doi:10.1542/peds.2010-1899
[56] D. Paripovic, M. Kostic, B. Spasojevic, D. Kruscic and A. Pecoantic, “Masked Hypertension and Hidden Uncontrolled Hypertension after Renal Transplantation,” Pediatric Nephrology, Vol. 25, No. 9, 2010, pp. 1719-1724. doi:10.1007/s00467-010-1552-8
[57] Z. Bircan, A. Duzova, N. Cakar, A. K. Bayazit, A. Elhan, E. Tutar, et al., “Predictors of Left Ventricular Hypertrophy in Children on Chronic Peritoneal Dialysis,” Pediatric Nephrology, Vol. 25, No. 7, 2010, pp. 1311-1318. doi:10.1007/s00467-010-1481-6
[58] E. Lurbe, J. Redon, J. M. Pascual, J. Tacons and V. Alvarez, “The Spectrum of Circadian Blood Pressure Changes in Type I Diabetic Patients,” Journal of Hypertension, Vol. 19, No. 8, 2001, pp. 1421-1428. doi:10.1097/00004872-200108000-00010
[59] E. Lurbe, J. Redon, A. Kesani, J. M. Pascual, J. Tacons, V. Alvarez, et al., “Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes,” New England Journal of Medicine, Vol. 347, No. 11, 2002, pp. 797-805. doi:10.1056/NEJMoa013410
[60] L. M. Ettinger, K. Freeman, J. R. DiMartino-Nardi and J. T. Flynn, “Microalbuminuria and Abnormal Ambulatory Blood Pressure in Adolescents with Type 2 Diabetes Mellitus,” Journal of Pediatrics, Vol. 147, No. 1, 2005, pp. 67-73. doi:10.1016/j.jpeds.2005.02.003
[61] D. Pall, M. Juhasz, S. Lengyel, C. Molnar, G. Paragh, B. Fulesdi, et al., “Assessment of Target-Organ Damage in Adolescent White-Coat and Sustained Hypertensives,” Journal of Hypertension, Vol. 28, No. 10, 2010, pp. 2139-2144.
[62] R. E. Kavey, D. A. Kveselis, N. Atallah and F. C. Smith, “White Coat Hypertension in Childhood: Evidence for End-Organ Effect,” Journal of Pediatrics, Vol. 150, No. 5, 2007, pp. 491-497. doi:10.1016/j.jpeds.2007.01.033
[63] M. Mitsnefes, J. Flynn, S. Cohn, J. Samuels, T. Blydt-Hansen, J. Saland, et al., “Masked Hypertension Associates with Left Ventricular Hypertrophy in Children with CKD,” Journal of the American Society of Nephrology, Vol. 21, No. 1, 2010, pp. 137-144. doi:10.1681/ASN.2009060609
[64] J. W. Graves and M. M. Althaf, “Utility of Ambulatory Blood Pressure Monitoring in Children and Adolescents,” Pediatric Nephrology, Vol. 21, No. 11, 2006, pp. 1640-1652. doi:10.1007/s00467-006-0175-6
[65] C. Gimpel, E. Wuhl, K. Arbeiter, D. Drozdz, A. Trivelli, M. Charbit, et al., “Superior Consistency of Ambulatory Blood Pressure Monitoring in Children: Implications for Clinical Trials,” Journal of Hypertension, Vol. 27, No. 8, 2009, pp. 1568-1574. doi:10.1097/HJH.0b013e32832cb2a8
[66] S. J. Swartz, P. R. Srivaths, B. Croix and D. I. Feig, “Cost-Effecttiveness of Ambulatory Blood Pressure Monitoring in the Initial Evaluation of Hypertension in Children,” Pediatrics, Vol. 122, No. 6, 2008, pp. 1177- 1181. doi:10.1542/peds.2007-3432
[67] C. B. Sethna, M. B. Leonard, P. R. Gallagher and K. E. Meyers, “Serum Adiponectin Levels and Ambulatory Blood Pressure Monitoring in Pediatric Renal Transplant Recipients,” Transplantation, Vol. 88, No. 8, 2009, pp. 1030-1037. doi:10.1097/TP.0b013e3181b9e1ec
[68] J. R. Ferraris, “ABPM vs Office Blood Pressure to Define Blood Pressure Control in Treated Hypertensive Paediatric Renal Transplant Recipients,” Pediatric Transplantation, Vol. 11, No. 1, 2007, pp. 24-30. doi:10.1111/j.1399-3046.2006.00595.x
[69] J. J. O’Sullivan, G. Derrick and J. Gray, “Blood Pressure after Cardiac Transplantation in Childhood,” Journal of Heart and Lung Transplantation, Vol. 24, No. 7, 2005, pp. 891-895. doi:10.1016/j.healun.2004.05.025
[70] S. L. Roche, J. Kaufmann, A. I. Dipchand and P. F. Kan- tor, “Hypertension after Pediatric Heart Transplantation Is Primarily Associated with Immunosuppressive Regimen,” Journal of Heart and Lung Transplantation, Vol. 27, No. 5, 2008, pp. 501-507. doi:10.1016/j.healun.2008.01.018
[71] S. L. Roche, J. J. O’Sullivan and P. F. Kantor, “Hypertension after Pediatric Cardiac Transplantation: Detection, Etiology, Implications and Management,” Pediatr Transplant, Vol. 14, No. 2, 2010, pp. 159-168. doi:10.1111/j.1399-3046.2009.01205.x
[72] M. E. Del Compare, D. D’Agostino, J. R. Ferraris, G. Boldrini, G. Waisman and R. T. Krmar, “Twenty-Four- Hour Ambulatory Blood Pressure Profiles in Liver Transplant Recipients,” Pediatr Transplant, Vol. 8, No. 5, 2004, pp. 496-501. doi:10.1111/j.1399-3046.2004.00192.x
[73] R. Agarwal and R. P. Light, “The Effect of Measuring Ambulatory Blood Pressure on Nighttime Sleep and Daytime Activity-Implications for Dipping,” Journal of the American Society of Nephrology, Vol. 5, No. 2, 2010, pp. 281-285. doi:10.2215/CJN.07011009

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.