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Methodology
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Measurement and interpretation of blood pressure
  1. C D A Goonasekeraa,
  2. M J Dillonb
  1. aFaculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, bDepartment of Nephrourology, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, 30 Guilford Street, London WC1N 1EH, UK
  1. Professor Dillon

https://doi.org/10.1136/adc.82.3.261

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    Mercury sphygmomanometry, the most widely used indirect method of blood pressure measurement, derived from the work of Scipione Riva-Rocci and Nicolai Korotkov forms the basis of our knowledge of the epidemiology of high blood pressure. Thus, recognised hypertension was first described as a specific clinical entity associated with an increased risk of strokes in the middle aged and elderly. However, it is now known that hypertension is a quantitative and not a qualitative deviation from the norm, and that there is no natural dividing line between normal and abnormal pressures.1

    The problem

    The main problem with interpreting measured blood pressure is its variability within the same individual and also between individuals, as determined by genetic and environmental factors. In addition, genetic and environmental influences can also vary from time to time within the same individual. Therefore, attempts at standardising blood pressure at a plateau before measurement (for example, British Hypertension Society criteria) have not been very successful because of diurnal variation and environmental influences (such as the “white coat effect”), particularly in children. This led to the tendency to use the mean value of several blood pressure measurements in clinical practice.

    Even with this approach there are two basic concerns regarding the interpretation of measured blood pressure in children. The first is the identification of “hypertension” as a disease entity using an epidemiological definition (for example, blood pressure above the 95th centile,2 or two standard deviations above the mean), which is purely a descriptive demarcation without an underlying biological meaning. This is because the association between increasing blood pressure and the increasing risk of future complications or shortening of life is continuous from lowest to highest values of systolic and diastolic blood pressure.3 The second concern relates to the identification of hypertension in children using the above definition, which …

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