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Variation in paediatric 24-h ambulatory blood pressure monitoring interpretation by Canadian and UK physicians

Abstract

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is widely accepted as a more accurate method for measurement of blood pressure (BP) compared to a single office-based measurement of BP. However, it is unclear how physicians interpret ABPM and make management decisions. This study’s goal is to investigate variation in ABPM interpretation among paediatric nephrologists (Canada and UK) and paediatric cardiologists (Canada only) via an online survey. The survey content included baseline demographics, questions on the use and indications for ABPM, interpretation of results, and subsequent management decisions in various clinical scenarios. The survey was sent to 196 Canadian physicians, with 69 (35.2%) total responses. Thirty-five UK clinicians also completed the survey. Most respondents were >44 years old, were in practice for at least 11 years, and were university-based. There were substantial differences among clinicians in ABPM interpretation for isolated systolic, diastolic, and night-time hypertension. For example, only 53.1% of physicians would initiate or modify treatment in those with diastolic HTN in CKD. Further, even for the same abnormal ABPM parameter, the decision to start or alter treatment was influenced by the underlying medical condition. There is significant variation in clinical practice among physicians for interpretation and management of hypertension when using ABPM. Differences in guidelines among various jurisdictions, as well as knowledge gaps in the research on which guidelines are based, create ambiguity regarding ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasoning behind the variation in physicians’ interpretation may help to standardise practice.

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Fig. 1: ABPM cut-off values to diagnose hypertension in children by nephrologists (from Canada and UK) and cardiologists (from Canada only). (N = 81).
Fig. 2: Canadian paediatric nephrologists’ alteration to treatment by ABPM parameter and underlying diagnosis. (N = 26).
Fig. 3: Canadian paediatric cardiologists’ alteration to treatment by ABPM parameter and underlying diagnosis. (N = 20).

Data availability

All data generated and analysed during this study are included in this published article and its corresponding supplementary information files.

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Acknowledgements

We would like to acknowledge all physicians who responded to our survey from UK and Canada.

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All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; and provided final approval of the version to be published.

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Correspondence to Isabella Z. Stefanova.

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The authors declare no competing interests.

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Ethics approval was acquired from the Hamilton Integrated Research Ethics Board (HiREB; project number 11383). The requirement for survey respondent consent was waived, as completion of the survey would confirm the respondents’ consent.

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Stefanova, I.Z., Sinha, M.D., Stewart, D.J. et al. Variation in paediatric 24-h ambulatory blood pressure monitoring interpretation by Canadian and UK physicians. J Hum Hypertens (2022). https://doi.org/10.1038/s41371-022-00702-z

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