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The prevalence of hypertension in children and adolescents is increasing. Electronic devices are frequently used in children for ambulatory, home and office blood pressure (BP) measurement. However, electronic BP monitors that have been successfully validated in adults might not be accurate in children, and separate validation is required. A review of validation studies in young individuals was performed, aiming to identify protocol violations, divergences and adaptations.

Design and method:

Published validation studies (PubMed) performed in infants, children and adolescents from 1996 till the end of 2015 using any of the established validation protocols (British Hypertension Society [BHS] protocol; US AAMI and/or International Standardization Organization [ISO]; European Society of Hypertension International Protocol [ESH-IP]) were included. All aspects of the protocols’ procedure were scrutinized using a standard checklist.


37 studies were identified (sample size 18–529 subjects). Sixteen studies (43%) used the BHS, 16 (43%) the AAMI and/or ISO and 5 (14%) the ESH-IP. The number of studies published per year were 4-5-2-5-2-5-8-3-3 for years 1996-98-2000-06-08-09-11-12-15 respectively. 21 studies (57%) tested devices for clinic/hospital use, 11 (30%) for ambulatory and 5 (13%) for home use. 26 studies reported a ’pass’ result for systolic and diastolic BP, 7 ’fail’ for systolic and diastolic BP, and 4 a ’fail’ only for diastolic BP. Two studies included infant/neonatal populations, 31 studies included children and adolescents and 4 included also adults. Same-arm sequential BP measurement procedure was applied in 24 studies (65%), same-arm simultaneous measurements in 6 studies and intra-arterial method in 2 studies (3 articles did not report the method used). Fourteen studies used Korotkoff sound V to define diastolic BP, 2 studies used K4, and 2 used K4 or K5 depending on the subject (9 articles did not report the sound used).


The validation of BP monitors in children has specific methodological issues and challenges which are not encountered in adults. The peer review process of scientific journals often misses important deficiencies of validation studies. Few validation studies of BP monitors in children have been published and more research is needed.

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