{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:17:30Z","timestamp":1785197850462,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as pulse pressure (PP), pulse pressure index (PPI), rate pressure product (RPP), ambulatory arterial stiffness index (AASI), and average real variability (ARV), remains underexplored in the pediatric population, particularly among children with chronic kidney disease (CKD). Objective: To evaluate the correlation between ABPM-derived indices in children, with a subgroup analysis comparing those with and without CKD. Secondary objectives included identifying factors associated with AASI and ARV and assessing their utility in cardiovascular risk stratification. Methods: In this bicentric cross-sectional study, 70 children (41 with CKD and 29 controls) were enrolled. ABPM indices (PP, PPI, RPP, AASI, and ARV) were calculated, and both descriptive and inferential statistical analyses, including linear regression, were performed. Results: Systolic and diastolic hypertension were significant predictors of elevated ARV (p &lt; 0.05), while body mass index (BMI) and glomerular filtration rate (GFR) were positively associated with AASI (p &lt; 0.05). Use of angiotensin-converting enzyme inhibitors (ACEIs) was associated with reduced arterial stiffness (p = 0.02). Significant differences were observed in weight, BMI, PP, and PPI between the CKD and non-CKD groups, with ABPM demonstrating greater sensitivity in detecting vascular health markers. Conclusions: ABPM-derived indices, particularly PP, PPI, and ARV, show promise in improving cardiovascular risk assessment in children. These findings support the broader use of ABPM metrics for refined cardiovascular evaluation, especially in pediatric CKD.<\/jats:p>","DOI":"10.3390\/children12070939","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T13:00:51Z","timestamp":1752757251000},"page":"939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ambulatory Blood Pressure Monitoring in Children: A Cross-Sectional Study of Blood Pressure Indices"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7433-0702","authenticated-orcid":false,"given":"Sulaiman K.","family":"Abdullah","sequence":"first","affiliation":[{"name":"Pediatric Department, College of Medicine, Taibah University, Madinah 41541, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1395-9555","authenticated-orcid":false,"given":"Ibrahim A.","family":"Sandokji","sequence":"additional","affiliation":[{"name":"Pediatric Department, College of Medicine, Taibah University, Madinah 41541, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha K.","family":"Al-Ansari","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of Excellence, Pediatric Nephrology Unit, Pediatric Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel A.","family":"Alsubhi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of Excellence, Pediatric Nephrology Unit, Pediatric Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Bahassan","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of Excellence, Pediatric Nephrology Unit, Pediatric Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Pediatric Department, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esraa","family":"Nawawi","sequence":"additional","affiliation":[{"name":"Pediatric Department, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawziah H.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Khamis Mushait Maternity & Children Hospital, Khamis Mushait 62454, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan N.","family":"Flimban","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of Excellence, Pediatric Nephrology Unit, Pediatric Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Pediatric Department, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of Excellence, Pediatric Nephrology Unit, Pediatric Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Pediatric Department, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7628-8926","authenticated-orcid":false,"given":"Jameela A.","family":"Kari","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Center of Excellence, Pediatric Nephrology Unit, Pediatric Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Pediatric Department, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1001\/jamapediatrics.2019.3310","article-title":"Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis","volume":"173","author":"Song","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.1161\/HYP.0000000000000215","article-title":"Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement from the American Heart Association","volume":"79","author":"Flynn","year":"2022","journal-title":"Hypertension"},{"key":"ref_3","first-page":"934","article-title":"Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents","volume":"23","author":"Hamdani","year":"2021","journal-title":"J. Clin. Hypertens."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1161\/HYPERTENSIONAHA.111.174938","article-title":"Ambulatory versus home versus clinic blood pressure: The association with subclinical cerebrovascular diseases: The Ohasama Study","volume":"59","author":"Hara","year":"2012","journal-title":"Hypertension"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1007\/s00467-011-1984-9","article-title":"Ambulatory Blood Pressure Monitoring in Children: Imperfect Yet Essential","volume":"26","author":"Flynn","year":"2011","journal-title":"Pediatr. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1161\/01.CIR.100.4.354","article-title":"Is Pulse Pressure Useful in Predicting Risk for Coronary Heart Disease? The Framingham Heart Study","volume":"100","author":"Franklin","year":"1999","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1038\/hr.2010.178","article-title":"Ambulatory Arterial Stiffness Index, Pulse Pressure, and Pulse Wave Velocity in Children and Adolescents","volume":"33","author":"Stergiou","year":"2010","journal-title":"Hypertens. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1038\/jhh.2015.66","article-title":"Average Real Variability of 24-h Systolic Blood Pressure is Associated with Microalbuminuria in Patients with Primary Hypertension","volume":"30","author":"Calcaterra","year":"2016","journal-title":"J. Hum. Hypertens."},{"key":"ref_9","first-page":"254","article-title":"Ambulatory Blood Pressure Monitoring in Pediatrics: An Update on Interpretation and Classification of Hypertension Phenotypes","volume":"24","author":"Basalely","year":"2022","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.2215\/CJN.02200222","article-title":"Arterial Stiffness and Chronic Kidney Disease Progression in Children","volume":"17","author":"Azukaitis","year":"2022","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_11","unstructured":"National Kidney Foundation (2002). K\/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Am. J. Kidney Dis., 39, S1\u2013S266."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","article-title":"Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1081\/CBI-100103970","article-title":"Circadian Rhythm of Double (Rate-Pressure) Product in Healthy Normotensive Young Subjects","volume":"18","author":"Hermida","year":"2001","journal-title":"Chronobiol. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/01.mbp.0000200478.19046.dd","article-title":"Ambulatory Arterial Stiffness Index: Rationale and Methodology","volume":"11","author":"Dolan","year":"2006","journal-title":"Blood Press. Monit."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/01.hjh.0000160205.81652.5a","article-title":"A Reliable Index for the Prognostic Significance of Blood Pressure Variability","volume":"23","author":"Mena","year":"2005","journal-title":"J. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1038\/s41390-020-01278-5","article-title":"Association of Blood Pressure, Obesity, and Physical Activity with Arterial Stiffness in Children: A Systematic Review and Meta-Analysis","volume":"91","author":"Lona","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2333794X19831297","DOI":"10.1177\/2333794X19831297","article-title":"Increased Arterial Stiffness in Adolescents with Obesity","volume":"6","author":"Lentferink","year":"2019","journal-title":"Glob. Pediatr. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/jch.12322","article-title":"Blood Pressure Variability in Children with Primary vs. Secondary Hypertension","volume":"16","author":"Leisman","year":"2014","journal-title":"J. Clin. Hypertens."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1038\/s41390-021-01841-8","article-title":"Blood Pressure Variability in Children with Obesity and Sleep-Disordered Breathing Following Positive Airway Pressure Treatment","volume":"92","author":"Myette","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/HJH.0000000000001158","article-title":"High glomerular filtration rate is associated with arterial stiffness in Chinese population","volume":"35","author":"Lin","year":"2017","journal-title":"J. Hypertens."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/jch.13905","article-title":"Association of Pulse Pressure, Pulse Pressure Index, and Ambulatory Arterial Stiffness Index with Kidney Function in a Cross-Sectional Pediatric Chronic Kidney Disease Cohort from the CKiD Study","volume":"22","author":"Raina","year":"2020","journal-title":"J. Clin. Hypertens."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1161\/HYPERTENSIONAHA.115.05516","article-title":"Decreased Arterial Elasticity in Children with Nondialysis Chronic Kidney Disease is Related to Blood Pressure and Not to Glomerular Filtration Rate","volume":"66","author":"Sinha","year":"2015","journal-title":"Hypertension"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1161\/01.HYP.0000160320.39303.ab","article-title":"Prevalence, persistence, and clinical significance of masked hypertension in youth","volume":"45","author":"Lurbe","year":"2005","journal-title":"Hypertension"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/HJH.0b013e32835e2a4a","article-title":"Genetic and Environmental Influences on Blood Pressure Variability: A Study in Twins","volume":"31","author":"Xu","year":"2013","journal-title":"J. Hypertens."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/939\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:10:52Z","timestamp":1760033452000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":24,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["children12070939"],"URL":"https:\/\/doi.org\/10.3390\/children12070939","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]}}}