The Impact of Changing Automated Blood Pressure Measurement Devices on Pediatric Blood Pressure

Elevated high blood pressures used to be common in adults, but recent data across the United States and Canada have shown they’re also a concern in pediatric populations. However, they’re more common in younger children aged 6–11 than in youth aged 12–17.  

According to the CHMS, the average blood pressure values in children and youth are as follows:  

•  Children aged 6 to 11: average resting blood pressure was 93/61 mmHg  

•  Youth aged 12 to 19: average resting blood pressure was 99/62 mmHg

This is an important routine check that’s helpful is checking and measuring blood pressure.  

This helps to manage unusual hikes in blood pressure estimates, as children with elevated blood pressure tend to become hypertensive adults. While blood pressure measurement used to only be done manually by health professionals in clinical settings, it can now be done at home using automated devices such as BpTRU and Omron.

Manual measurement of blood pressure (BP) has been proven to be inferior in accuracy when compared with ambulatory BP measurements (ABPM), since it misses white coats and masked effects on BP. Automated models like BpTRU have been reported to reduce the white coat effect.  

Accuracy disputes exist between the two models, BPTRU and OMRON—a comparison of efficiency and accuracy. This article seeks to explain whether transitioning between both models can affect blood pressure (BP) estimates in children and youth.

Prevalence of Hypertension in Children and Youth  

While hypertension remains a public health concern, pediatric hypertension has increased significantly over the years since 2007 1. Despite the serious health implications this poses, research gaps in pediatric hypertension still exist and can be fatal.  

An implication of this is the discrepancies in the measurement of BP—complex interpretation of BP measurements across automated devices. The table below shows the BP measurement and hypertension thresholds of the pediatric population across America, Europe, and Canada.

Table 1. Classification of BP in children and adolescents by the American Academy of Pediatrics 2017, European Society of Hypertension 2016, and Hypertension Canada 2020 guidelines.

Guidelines	American Academy of Pediatrics (2017)	European Society of Hypertension (2016)	Hypertension Canada (2o20)
BP screening and measurement	Annual BP measurement in children ≥ 3 years of age or at every visit if risk factors for hypertension Oscillometric methods can be used for screening but must be confirmed by auscultatory method Elevated BP should be confirmed on 3 separate visits ABPM recommended	BP measurement should be performed in children ≥ 3 years of age, can repeat every 2 years if BP is normal Auscultatory method preferred Elevated BP should be confirmed on 3 separate clinic visits ABPM recommended	BP should be regularly measured in children ≥ 3 years of age, no recommendation on screening frequency Oscillometric methods can be used for screening but must be confirmed by auscultatory method Elevated BP should be confirmed on 3 separate visits ABPM should be considered
Hypertension threshold	≥95th percentile (13 yr) Or ≥130/80 mm Hg (≥13 yr)	≥95th percentile (16 years) Or ≥140/90 mm Hg (≥16 yr)	≥95th percentile Or  >120/80 mm Hg (6-11 yr) Or  >130/85 mm Hg (≥12 yr)
Target BP (General pediatric population)	< 90th percentile (<13 years) Or <130/80 (≥13 yr)	<95th percentile recommended <90th percentile should be considered	<95th percentile <90th percentile (for patients with risk factors or target organ damage)
Target BP (pediatric CKD)	24-h MAP (by ABPM) of <50th percentile	<75th percentile (non-protein uric CKD)	<90th percentile

Comparison Parameters  

The parameters assessed in the study were systolic blood pressure (SBP) and diastolic blood pressure (DBP). The variability of both models was compared across factors such as sex, age, and height of the children and youth.

Despite medical advances in recent years, the prevention, diagnosis, and treatment of high blood pressure in children and adolescents still have room for improvement. Essential elements such as the measurement devices, regulated procedures, and interpretation of results based on percentiles according to age, gender, and height make up the correct measurement of blood pressure, especially in children.  

Data Comparison Between BpTRU and OMRON Measurement of BP Estimates  

A study found that automated devices had a significant effect on SBP. The results of this study  was the first time two widely used automated devices—the Omron and the BpTRU—were directly compared in both open and closed areas. Omron’s SBP measurements exceeded BpTRU SBP measurements by almost 5 mmHg on average, especially at lower BP levels. 

According to the most recent data from the Canadian Health Measures Survey (CHMS), overall mean SBP measured with Omron was 9 millimeters of mercury (mmHg) higher than that measured with BpTRU. Mean DBP measured with Omron was 3 mm Hg lower than that measured with BpTRU. The average between-device difference across characteristics ranged from +4 to +12 mmHg for SBP and -5 to +2 mmHg for DBP. The mean difference in SBP between the two devices was similar for boys (9 mmHg) and girls (8 mmHg), and increased for both sexes with increasing age. The mean difference in DBP between devices was -4 mmHg for boys versus -2 mmHg for girls. The pattern of difference in DBP across age groups and increasing BMI or risk of central obesity was not the same for both sexes.  

Magnitude/Direction of Differences in Measurement  

Another study reported that BpTRU is the most widely used and studied device in Canada. It allows unattended BP assessment, hence reducing the incidence of the white coat effect. Because of this, it excluded other automated devices including Omron (Kyoto, Japan), as it’s not widely in use. These other devices do not always exclude the first reading and use fewer readings to obtain the average BP. This supports the idea that automated BP measurement devices provide similar average BP estimates but generate many discordant results.

Clinical Significance & Implication: Impact on Hypertension Diagnosis Rates  

Although the different areas did not influence BP estimates, the Omron HEM significantly exceeded BpTRU measurements on average, especially at lower BP levels. These differences should be considered when interchanging devices, as they could have clinical decision impacts in a population of pediatric patients treated for hypertension.  

References

1. Blanchard J. Health Fact Sheets: Hypertension among children and youth, 2007-2019. Statistics Canada. Published October 10, 2024. Accessed April 12, 2025. https://www150.statcan.gc.ca/n1/pub/82-625-x/2024001/article/00001-eng.htm  

2. Edwards C, Hiremath S, Gupta A, McCormick BB, Ruzicka M. BpTRUth: Do automated blood pressure monitors outperform mercury? J Am Soc Hypertens. 2013;7(6):448-453. doi:10.1016/j.jash.2013.07.002  

3. Robinson CH, Chanchlani R. High blood pressure in children and adolescents: current perspectives and strategies to improve future kidney and cardiovascular health. Kidney Int Rep. 2022;7(5):954-970. doi:10.1016/j.ekir.2022.02.018  

4. Álvarez J, Aguilar F, Lurbe E. Blood pressure measurement in children and adolescents: key element in the evaluation of arterial hypertension. Anales dePediatria (Engl Ed). 2022;96(6):536.e1-536.e7. doi:10.1016/j.anpede.2022.04.011  

5. Rinfret F, Cloutier L, Wistaff R, et al. Comparison of different automated office blood pressure measurement devices: evidence of nonequivalence and clinical implications. Can J Cardiol. 2017;33(12):1639-1644. doi:10.1016/j.cjca.2017.09.011  

6. Jegatheswaran J, Ruzicka M, Hiremath S, Edwards C. Are automated blood pressure monitors comparable to ambulatory blood pressure monitors? A systematic review and meta-analysis. Can J Cardiol. 2017;33(5):644-652. doi:10.1016/j.cjca.2017.01.020  

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