Updates to Pediatric Ambulatory Blood Pressure Monitoring in Clinical Practice: a Review and Strategies for Expanding Access

Purpose of ReviewTo discuss blood pressure classification using ambulatory blood pressure monitoring (ABPM) according to the new American Heart Association 2022 pediatric ABPM guidelines, ABPM evidence and epidemiology of hypertension disorders, and the potential role of ABPM in primary care.Recent FindingsPediatric hypertension remains underdiagnosed with an increasing prevalence worldwide. Clinic blood pressure is widely used to screen for and diagnose hypertension but has limitations such as inability to detect white coat effect, nocturnal blood pressure patterns, or masked hypertension. ABPM is the gold standard for diagnosing hypertension disorders in youth as well as adults, yet its adoption remains low.SummaryWidespread use of ABPM could improve gaps that currently exist in the screening, diagnosis, and care of youth with hypertension disorders in an efficient and cost-effective way. While ABPM access is often limited to pediatric sub-specialist clinics with limited geographical reach, improved access to this important tool could be supported by lowering barriers to its use by primary care providers and others in the community. As a community that provides care for youth with hypertension and those at risk for hypertension disorders, we strive to increase local access to ABPM devices, advocate for reliable reimbursement for the procedure, and promote educational programs for clinicians interested in providing ABPM with the goal of earlier and more accurate diagnoses of hypertension to improve short- and long-term outcomes among children.