Paediatrics: Hypertension: definition
Normal: systolic and diastolic <90th centile.
Defined by reference to sex, height centile charts (see Fig. 11.1).
- Normal: systolic and diastolic <90th centile.
- High normal: systolic or diastolic between 90th and 95th centile.
- Hypertension: systolic or diastolic >95th centile.
- Severe hypertension: systolic or diastolic >99th centile.
BP measurement should be part of a routine examination.
- Cuff size.
- bladder width—70% of acromion olecranon distance or 40%
o mid-arm circumference;
o bladder length—should completely encircle arm.
o Note: small cuff area is a common cause of false-positive high BP!
- After 5min rest (ideally!).
- A sitting position with the arm at the level of the heart (children).
- Supine position in infants.
- On auscultation: 1st and 5th (disappearance) Korotkoff sounds used for systolic and diastolic values, respectively.
- Manual oscillometric sphygmomanometer (mercury is now withdrawn).
- Doppler: infants (for systolic pressure).
- Automatic oscillometry: not all devices suitable.
- Ambulatory blood pressure monitoring (ABPM) for 24-hr profiles:
o little normative data in paediatrics;
o significant hypertension ≥30% readings above 95th centile.
- Intra-arterial (in intensive therapy unit (ITU) setting).