Blood pressure readings in children can vary in each arm, raising misdiagnosis risk

MELBOURNE, Australia — A recent study has revealed that a child’s blood pressure can differ from one arm to the other. Since these measurements often play a major role in how doctors diagnose certain illnesses, researchers at Murdoch Children’s Research Institute (MCRI) and the University of Melbourne say this may lead to the misdiagnoses of serious conditions.

The team suggests that checking both arms when examining children is the safest way to go to avoid a misdiagnosis of hypertension.

The first-of-its-kind study included 118 children between the ages of seven and 18. Researchers, including MCRI Ph.D. candidate and study lead author Melanie Clarke, obtained blood pressure measurements from both arms of each participant.

1 in 4 have differing blood pressure readings in their arms

Results showed approximately 25 percent of healthy participants had discrepancies in their arm measurements. Furthermore, 50 percent of those who had undergone heart surgery showed differences in their blood pressure from one arm to the other. Since there is a fine line between normal and elevated blood pressure, these changes make it difficult for doctors to properly diagnose children.

“Misdiagnosis could occur when the blood pressure difference is greater than about 5 mmHg, but one in seven healthy children had a difference greater than 10 mmHg, which could lead to a failure to identify stage one or two hypertension,” says Clarke in a university release. “Given blood pressure measured in a child’s right and left arm are often different, it’s important to take measurements in both arms to make a correct diagnosis. Accurate blood pressure assessment in kids is critical for identifying the potential risk for damage to the heart and blood vessels, which can lead to early-onset cardiovascular disease.”

High blood pressure exacerbates cardiovascular disease and stroke risk, the two main causes of death in the world. According to MCRI Associate Professor Jonathan Mynard, children with high blood pressure have an increased risk for developing hypertension during adulthood at a reasonably early age. The prevalence of pediatric hypertension worldwide is around four percent. The ongoing stress of elevated blood pressure causes damage to the cardiovascular system.

“Children with high blood pressure, many of whom appear to be healthy, have a greater risk of developing hypertension in adulthood, a major risk factor for cardiovascular disease,” says Prof. Mynard.

High blood pressure ‘common’ in kids

Many general practitioners do not always measure blood pressure in children due to the misconception that high blood pressure usually only occurs in adults. Now, the European Society of Hypertension and the American Academy of Pediatrics advise that pediatricians check the blood pressure of children and teenagers at least once a year — and in both arms.

“We know high blood pressure is common in adults but many people don’t realize how common it is in kids too,” Mynard adds. “More work needs to be done to draw attention to the problem of childhood hypertension and its long-term consequences.”

Experts also suggest that parents encourage healthier eating habits and more physical activity to help their children maintain a healthier weight and better heart health.

“There are good clinical reasons for measuring blood pressure in both arms in children and adolescents in the evaluation of hypertension and this study provides clear support for this approach,” concludes Dr. Gary Jennings, the Heart Foundation Chief Medical Advisor and Executive Director of Sydney Health Partner.

The study is published in the Journal of Hypertension.

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