Feasibility of ambulatory blood pressure monitoring in primary care

Pediatric hypertension remains a critical yet underdiagnosed contributor to long-term cardiovascular disease (CVD), according to findings presented by Carissa Baker-Smith, MD, MPH, at the 2025 American College of Cardiology (ACC) conference.

Baker-Smith, director of Research and Preventive Cardiology at Nemours Children’s Cardiac Center, shared study results from the poster "Point of Care Ambulatory Blood Pressure Monitoring for Improved Hypertension Diagnosis in Youth." Results demonstrated that implementing ambulatory blood pressure monitoring (ABPM) at the point of care can significantly enhance hypertension diagnosis in children.

"This project was really important because it address[ed] an important condition, hypertension, one of the top drivers of cardiovascular health status in the world," Baker-Smith said. "Providers may not feel comfortable with the in-office measurement, knowing whether or not that measurement is actually high because the child has hypertension or high because the child is nervous."

The mixed-methods study included 60 children aged 10 to 17 years from a high-deprivation urban practice in Wilmington, Delaware, each with a single in-office manual BP ≥ 95th percentile. The approach utilized ABPM device placement during the same visit, allowing real-time diagnosis.

Acceptance of point-of-care ABPM was high, with 97% of families agreeing to participate. Tolerability scores were greater than 4 (on a scale of 5, in which 5 was "best") for daytime and nighttime wear by 57% and 51% of participants, respectively. Furthermore, findings showed that averaging 3 in-office systolic BP readings correlated poorly with ABPM, while averaging 10 readings showed significantly better correlation (P = 0.03) (1).

"Imagine... you had no idea that your child has hypertension, but you easily find out in a way that the provider is sure that the results aren’t related to the fact that the child has anxiety," Baker-Smith said. She added that clear communication of ABPM results empowers families to take action through lifestyle changes such as reduced sodium intake and increased physical activity.

Beyond hypertension, the 24-hour ABPM captured data that led to additional diagnoses, including potential sleep apnea, as elevated nocturnal BP prompted further referrals.

"The primary care setting really is a medical home... and the primary provider is being equipped with the information that they need to communicate most effectively and confidently," added Baker-Smith. "Studies like the one that we conducted not only give parents and providers the information that they need, but they also motivate them, or can be motivating drivers to intervention."

Baker-Smith's disclosures include Merck Pharmaceuticals, Nemours Children's Health, AHRQ, PCORI, NIGMS, Medscape, ACC, AHA.

Reference:

Baker-Smith C. Point of Care Ambulatory Blood Pressure Monitoring for Improved Hypertension Diagnosis in Youth. Poster. Presented at: 2025 American College of Cardiology. Chicago, IL. March 29-31, 2025.