Andersons pediatric cardiology 1601

and corresponds to the intra-arterial pressure better than any other method, including auscultation.34 It is less reliable in the measurement of diastolic pressure, even when machines specifically designed for diastolic pressure are used.35 All hospital pediatric departments, especially those specializing in pediatric cardiology and nephrology, should have an ultrasonic machine for measurement of blood pressure It is particularly useful in determining pressure in the legs in children with suspected aortic coarctation.34 Recording of the systolic blood pressure by palpation of the radial artery underestimates the pressure by as much 11 mm Hg.34 The blood pressure measurement should be recorded immediately, without rounding off the measured value to the nearest preferred whole value The number of measurements to be obtained for each visit in order for the observer to be assured that the measured pressure is accurate is also important In practical terms, an observer should attempt to take at least two but preferably three measurements at each visit The second and third measurements are a truer reflection of the pressure, the first being least accurate, especially when measured with an automated oscillometric instrument Measurements over three visits should be considered to provide a better reflection of a given blood pressure.9,20,36 In 2016, the European Society of Hypertension published revised guidelines regarding the definitions of hypertension, with those 16 years and older now being categorized as hypertensive per adult definitions (Tables 60.2 and 60.3).36 Table 60.2 Blood Pressure for Boys by Age and Height Percentiles Percentile of Height (SBP, mm Hg) Age (y) BP Percentile 5th 10th 25th 50th 75th 90th 90th 94 95 97 99 100 102 95th 98 99 101 103 104 106 99th 105 106 108 110 112 113 90th 97 99 100 102 104 105 95th 101 102 104 106 108 109 99th 109 110 111 113 115 117 90th 100 101 103 105 107 108 95th 104 105 107 109 110 112 99th 111 112 114 116 118 119 90th 102 103 105 107 109 110 95th 106 107 109 111 112 114 99th 113 114 116 118 120 121 Percentile of Height (DBP, mm Hg) 95th 5th 10th 25th 50th 75th 90th 103 49 50 51 52 53 53 106 54 54 55 56 57 58 114 61 62 63 64 65 66 106 54 55 56 57 58 58 110 59 59 60 61 62 63 117 66 67 68 69 70 71 109 59 59 60 61 62 63 113 63 63 64 65 66 67 120 71 71 72 73 74 75 111 62 63 64 65 66 66 115 66 67 68 69 70 71 122 74 75 76 77 78 78 95th 54 58 66 59 63 71 63 67 75 67 71 79 10 11 12 13 14 15 16a 17a 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 90th 95th 99th 104 108 115 105 109 116 106 110 117 107 111 119 109 113 120 111 115 122 113 117 124 115 119 126 117 121 128 120 124 131 122 126 134 125 129 136 127 131 139 105 109 116 106 110 117 107 111 118 109 112 120 110 114 121 112 116 123 114 118 125 116 120 127 118 122 130 121 125 132 124 127 135 126 130 137 128 132 140 106 110 118 108 112 119 109 113 120 110 114 122 112 116 123 114 117 125 115 119 127 118 122 129 120 124 131 123 127 134 125 129 136 128 132 139 130 134 141 108 112 120 110 114 121 111 115 122 112 116 123 114 118 125 115 119 127 117 121 129 120 123 131 122 126 133 125 128 136 127 131 138 130 134 141 132 136 143 110 114 121 111 115 123 113 117 124 114 118 125 115 119 127 117 121 128 119 123 130 121 125 133 124 128 135 126 130 138 129 133 140 131 135 143 134 138 145 111 115 123 113 117 124 114 118 125 115 119 127 117 121 128 119 122 130 120 124 132 123 127 134 125 129 136 128 132 139 130 134 142 133 137 144 135 139 146 112 116 123 113 117 125 115 119 126 116 120 127 118 121 129 119 123 130 121 125 132 123 127 135 126 130 137 128 132 140 131 135 142 134 137 145 136 140 147 65 69 77 68 72 80 70 74 82 71 75 83 72 76 84 73 77 85 74 78 86 74 78 86 75 79 87 75 80 87 76 81 88 78 82 90 80 84 92 66 70 78 68 72 80 70 74 82 72 76 84 73 77 85 73 78 86 74 78 86 75 79 87 75 79 87 76 80 88 77 81 89 78 83 90 80 85 93 67 71 79 69 73 81 71 75 83 72 77 85 74 78 86 74 79 86 75 79 87 75 80 88 76 80 88 77 81 89 78 82 90 79 83 91 81 86 93 68 72 80 70 74 82 72 76 84 73 78 86 75 79 87 75 80 88 76 80 88 76 81 89 77 81 89 78 82 90 79 83 91 80 84 92 82 87 94 69 73 81 71 75 83 73 77 85 74 79 87 76 80 88 76 81 88 77 81 89 77 82 90 78 82 90 79 83 91 80 84 92 81 85 93 83 87 95 69 74 81 72 76 84 74 78 86 75 79 87 76 81 88 77 81 89 78 82 90 78 82 90 79 83 91 79 84 92 80 85 93 82 86 94 84 88 96 70 74 82 72 76 84 74 78 86 76 80 88 77 81 89 78 82 90 78 82 90 79 83 91 79 83 91 80 84 92 81 85 93 82 87 94 84 89 97 aBlood pressure levels from the Fourth Report9 and boxed area corresponds to reference values for boys 16 years and older for whom reference values for adults are now recommended DBP, Diastolic blood pressure; SBP, systolic blood pressure From Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents J Hypertens 2016;34(10):1887–1920 Table 60.3 Blood Pressure for Girls by Age and Height Percentiles Percentile of Height (SBP, mm Hg) Age (y) BP Percentile 5th 10th 25th 50th 75th 90th 90th 97 97 98 100 101 102 95th 100 101 102 104 105 106 99th 108 108 109 111 112 113 90th 98 99 100 101 103 104 95th 102 103 104 105 107 108 99th 109 110 111 112 114 115 90th 100 100 102 103 104 106 95th 104 104 105 107 108 109 99th 111 111 113 114 115 116 90th 101 102 103 104 106 107 95th 105 106 107 108 110 111 99th 112 113 114 115 117 118 90th 103 103 105 106 107 109 95th 107 107 108 110 111 112 99th 114 114 116 117 118 120 90th 104 105 106 108 109 110 95th 108 109 110 111 113 114 99th 115 116 117 119 120 121 90th 106 107 108 109 111 112 95th 110 111 112 113 115 116 99th 117 118 119 120 122 123 90th 108 109 110 111 113 114 95th 112 112 114 115 116 118 99th 119 120 121 122 123 125 90th 110 110 112 113 114 116 95th 114 114 115 117 118 119 99th 121 121 123 124 125 127 10 90th 112 112 114 115 116 118 95th 116 116 117 119 120 121 99th 123 123 125 126 127 129 11 90th 114 114 116 117 118 119 95th 118 118 119 121 122 123 99th 125 125 126 128 129 130 12 90th 116 116 117 119 120 121 95th 119 120 121 123 124 125 99th 127 127 128 130 131 132 13 90th 117 118 119 121 122 123 95th 121 122 123 124 126 127 99th 128 129 130 132 133 134 14 90th 119 120 121 122 124 125 95th 123 123 125 126 127 129 99th 130 131 132 133 135 136 15 90th 120 121 122 123 125 126 95th 124 125 126 127 129 130 99th 131 132 133 134 136 137 16a 90th 121 122 123 124 126 127 95th 125 126 127 128 130 131 99th 132 133 134 135 137 138 17a 90th 122 122 123 125 126 127 95th 125 126 127 129 130 131 95th 103 107 114 105 109 116 106 110 117 108 112 119 109 113 120 111 115 122 113 116 124 114 118 125 116 120 127 118 122 129 120 124 131 122 126 133 124 128 135 125 129 136 127 131 138 128 132 139 128 132 Percentile of Height (DBP, mm Hg) 5th 10th 25th 50th 75th 90th 52 53 53 54 55 55 56 57 57 58 59 59 64 64 65 65 66 67 57 58 58 59 60 61 61 62 62 63 64 65 69 69 70 70 71 72 61 62 62 63 64 64 65 66 66 67 68 68 73 73 74 74 75 76 64 64 65 66 67 67 68 68 69 70 71 71 76 76 76 77 78 79 66 67 67 68 69 69 70 71 71 72 73 73 78 78 79 79 80 81 68 68 69 70 70 71 72 72 73 74 74 75 80 80 80 81 82 83 69 70 70 71 72 72 73 74 74 75 76 76 81 81 82 82 83 84 71 71 71 72 73 74 75 75 75 76 77 78 82 82 83 83 84 85 72 72 72 73 74 75 76 76 76 77 78 79 83 83 84 84 85 86 73 73 73 74 75 76 77 77 77 78 79 80 84 84 85 86 86 87 74 74 74 75 76 77 78 78 78 79 80 81 85 85 86 87 87 88 75 75 75 76 77 78 79 79 79 80 81 82 86 86 87 88 88 89 76 76 76 77 78 79 80 80 80 81 82 83 87 87 88 89 89 90 77 77 77 78 79 80 81 81 81 82 83 84 88 88 89 90 90 91 78 78 78 79 80 81 82 82 82 83 84 85 89 89 90 91 91 92 78 78 79 80 81 81 82 82 83 84 85 85 90 90 90 91 92 93 78 79 79 80 81 81 82 83 83 84 85 85 95th 56 60 67 61 65 72 65 69 76 68 72 79 70 74 81 72 76 83 73 77 84 74 78 86 75 79 87 76 80 88 77 81 89 78 82 90 79 83 91 80 84 92 81 85 93 82 86 93 82 86