Reproducibility of Office and Out-of-Office Blood Pressure Measurements in Children: Implications for Clinical Practice and Research.

This study aimed to evaluate the reproducibility of office (OBP), ambulatory (ABP), and home blood pressure (HBP) measurements in children and adolescents, and their implications in diagnosing hypertension in clinical practice and in pediatric hypertension research. Apparently healthy children and adolescents referred for suspected hypertension were included. Measurements of 2-visit OBP, 7-day HBP, and 24-hour ABP were performed twice, 1 to 6 months apart. Reproducibility was quantified using the SD of differences between repeated measurements. The sample size of clinical trials comparing the efficacy of antihypertensive drugs using each method was calculated. Fifty-eight individuals were analyzed (mean age, 13.0±2.9 years, 60.3% boys). The reproducibility of 24-hour ABP (SD of differences 5.7/4.5 systolic/diastolic) and HBP (5.9/5.0 mm Hg) were comparable and superior to that of visit-2 OBP (9.2/7.8) and awake (6.7/5.5) or asleep ABP (7.6/6.1). As a consequence, a parallel-group comparative trial aiming to detect a difference in the effect of 2 drugs of 10 mm Hg systolic BP, would require 36 participants when using OBP measurements, 14 using 24-hour ABP, and 15 using HBP (102/34/42 respectively for detecting a 5 mm Hg difference in diastolic BP). For a crossover design trial, the corresponding sample sizes are 9/3/4 for systolic BP and 26/9/11 for diastolic, respectively. These data suggest that in children and adolescents 24-hour ABP and 7-day HBP have similar reproducibility, superior to OBP and daytime or asleep ABP. These findings have major implications in diagnosing hypertension in children in clinical practice and in designing clinical research trials in pediatric hypertension.

Hypersensitivity reactions to oxaliplatin: a retrospective study and the development of a desensitization protocol.

BACKGROUND: We recorded the epidemiologic and clinical features of hypersensitivity reactions (HSRs) to oxaliplatin in colorectal cancer (CRC) patients in order to provide information on the management of these patients. We also developed a desensitization protocol and evaluated its clinical application. For these reasons, we analyzed retrospectively the records of 215 CRC patients treated with oxaliplatin-containing regimens either as an adjuvant, first-line, second-line, or more. PATIENTS AND METHODS: Data from 52 patients with HSRs were analyzed according to the Common Toxicity Criteria for Adverse Events (CTCAE), v3.0. Three patients were chosen for the desensitization protocol. After determining the starting point for desensitization, we applied the standard protocol for parenteral desensitization to b-lactam antibiotics. Oxaliplatin treatment was then carried out with serial 10-fold dilutions in sufficient volume to administer the total dose. A total of 52 patients (24.2%) were recorded as having an allergic reaction to oxaliplatin. RESULTS: Hypersensitivity reactions were recorded after a mean of 6.5 (SD +/- 4.5) cycles. Only 4 patients (4 of 215; 1.8%) developed CTCAE grade 3/4 HSRs. Hypersensitivity reactions were seen more likely in patients receiving second-line or more of chemotherapy compared with chemotherapy-naive patients. No other correlations were seen (the presence of atopic disease, positive skin prick test). The 3 patients, having completed the parenteral desensitization protocol, completed their treatment uneventfully as well. CONCLUSION: Hypersensitivity reactions from oxaliplatin respond quickly to the discontinuation of the drug and appropriate support. Premedication and an increased infusion time could allow for readministration. The desensitization protocol we developed can provide a reliable alternative to permanent discontinuation of oxaliplatin.

Home blood pressure monitoring in children: how many measurements are needed?

OBJECTIVE: To investigate the minimum schedule of blood pressure (BP) measurements necessary to provide a reliable assessment of home BP (HBP) in children and adolescents. METHODS: Subjects aged 6-18 years referred for elevated BP were assessed with HBP monitoring (6 workdays, duplicate morning and evening measurements) and 24-h ambulatory BP monitoring (ABP). Criteria for HBP reliability were its reproducibility (test-retest correlations and SD of differences (SDDs) between repeated measurements), its stability (average home BP of an increasing number of readings and its SD), and its relationship with ABP. RESULTS: Data from 100 subjects were analyzed (mean age 13 +/- 2.8 (SD) years, 61 boys). The reproducibility of 3-day HBP (r 0.88/0.79, SDDs 5.1/4.9, systolic/diastolic) was superior to that of a single (r 0.79/0.65, SDDs 7.6/7.1) or 2-day HBP (r 0.85/0.72, SDDs 6.1/5.4). By averaging up to 12 readings (3 days), there was a progressive decline in average HBP, with no further decline thereafter. The SD of average HBP was also progressively reduced, with little change after day 3. The association of HBP with ABP was improved by averaging more readings up to 12, with no further improvement when more readings were averaged. The exclusion of first-day measurements slightly increased the SD of average HBP and weakened the correlation with ABP, probably due to reduced number of readings. CONCLUSIONS: In children and adolescents, 3-day monitoring with duplicate morning and evening measurements appears to be the minimum schedule for the reliable assessment of HBP.

Safety and efficacy of zoledronic acid rapid infusion in lung cancer patients with bone metastases: a single institution experience.

Zoledronic acid (Zometa, Novartis, Basel, Switzerland) is a new generation of bisphosphonates (BPs) with demonstrated clinical benefit in breast and prostate cancer patients with bone metastases. The safety and efficacy of intravenous zoledronic acid in lung cancer patients was assessed. In 86 patients with newly diagnosed non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) and bone metastases, 4 mg of zoledronic acid was administered with rapid 15-minute intravenous infusion every 3-4 weeks. A total of 414 infusions were administered over a 24-month period during which a statistically significant decrease in serum calcium levels (p = 0.03) was observed. Serum alkaline phosphatase (ALP) also decreased but not significantly. With regard to clinical efficacy, 55 of our patients stabilized or reduced their need for analgesic treatment. No significant side-effects, including fever, hemodynamic instability and renal dysfunction, were seen. We conclude that the rapid infusion of zoledronic acid is safe and convenient for lung cancer patients even after the 3rd and 6th months follow-up.

Report of two cases of endobronchial metastases secondary to colorectal cancer.

Two cases of endoluminar/endobronchial metastases (EEM) from a secondary extrathoracic tumour are reported. The patients, eight years after the curative treatment of colorectal adenocarcinoma, were examined exhibiting pulmonary symptoms with radiological findings in the chest and endobronchial lesions as an initial presentation. The use of fiberoptic bronchoscopy of endoluminar/endobronchial lesions may help in diagnosing the origin of metastatic spread in the presence or absence of a primary tumour.

Pegylated Liposomal Doxorubicin HCL (Caelyx) in combination with Sandostatin LAR as salvage therapy in patients with small-cell lung cancer.

BACKGROUND: The aim of the present study was to evaluate the efficacy of Pegylated Liposomal Doxorubicin (Caelyx) combined with Sandostatin LAR as salvage treatment of small cell lung cancer (SCLC) in platinum-pretreated patients. PATIENTS AND METHODS: Nine pretreated patients (median age 53.5 years, PS: 0-1) with histologically confirmed SCLC were treated with Caelyx 40 mg/m2 (i.v.) on day 1 and Sandostatin LAR 30 mg (i.m.) on day 1 every 28 days. Four (44%) out of the nine patients had received two prior regimens and five (55%) were refractory to front-line chemotherapy. RESULTS: No complete or partial responses were observed. Disease stabilization was obtained in two (22%) patients. The median overall survival was 18.7 months and the median time to progression was 9.1 months. CONCLUSION: The combination of Caelyx and Sandostatin LAR was inactive as salvage treatment in this poor prognosis group of patients with relapsed SCLC. However, the combination would merit further investigation in patients pretreated with one prior regimen.

Metastatic cervical carcinoma to the thyroid gland: a case report and review of the literature.

Although metastases within the thyroid gland are rare, they are not as infrequent as generally believed. Asymptomatic breast, lung, and renal cell carcinomas may metastasize to the thyroid. When they become symptomatic, diagnosis relies upon fine needle aspiration cytology. We report the case of a squamous cell cervical cancer that presented metastatic lesions to the thyroid gland four years after the initial diagnosis. The procedures used to confirm the diagnosis, stage, and subsequently manage the patient are described. We present both a review of the necessary clinical investigation and the therapeutic options open to these patients. We conclude that patients who present swelling or palpable nodules in the thyroid side and have a history of a previous malignancy must be considered for metastatic disease.

Bi-weekly administration of docetaxel and gemcitabine as first-line therapy for non-small cell lung cancer: a phase II study.

BACKGROUND: The standard treatment for advanced non-small cell lung cancer (NSCLC) currently consists of platinum-based, combination chemotherapy of limited efficacy and possible toxicity. The bi-weekly administration of docetaxel and gemcitabine for advanced NSCLC was evaluated in a phase II study (objective response rate, median survival, median duration of response and safety). PATIENTS AND METHODS: A total of 170 cycles were administered to 31 patients with advanced NSCLC and a median age of 66 years (range 47-75 years). Patients received docetaxel 80 mg/m2 and gemcitabine 1000 mg/m2 on days 1 and 14 of a 28-day cycle. RESULTS: Sixteen patients achieved a PR (16/31, 55.2%), 3 patients had SD (3/31, 10.3%) and 10 (10/31, 34.5%) had PD. The median time to disease progression was 3 months (range 0-12 months) with a mean survival of 10 months (range 3-31 months). Haematological and non-haematological toxic effects were generally mild to moderate and manageable: Grade 3 neurotoxicity and allergy occurred in 2 patients (6.4%) and 1 patient (3.2%), respectively. Peripheral neuropathy, mostly grades 1 and 2, was reported in 24 patients (77.4%). CONCLUSION: The bi-weekly administration of a docetaxel/gemcitabine combination with G-CSF support constitutes a tolerable and convenient regimen for the treatment of advanced NSCLC, with efficacy similar to that reported in other regimens.

White-coat hypertension and masked hypertension in children.

The use of ambulatory blood pressure monitoring in addition to the conventional office measurements makes possible the detection of individuals with white-coat hypertension and masked hypertension. In children referred for elevated blood pressure, both these phenomena appear to be common (10-15% for each). In a population of healthy children, white-coat hypertension appears to be as common as hypertension, whereas masked hypertension appears to be more common than white-coat hypertension or hypertension. In children with persistent white-coat or masked hypertension, assessment of target organ damage by echocardiography is required. Preliminary evidence suggests that, in contrast to white-coat hypertension, which is not associated with target organ damage, masked hypertension in children is associated with increased left ventricular mass. Children with masked hypertension should be followed up and possibly treated for hypertension if the phenomenon persists or there is evidence of target organ damage.

Home or self blood pressure measurement? What is the correct term?

OBJECTIVE: Blood pressure measurements taken by patients at home (HBP) are usually referred to as 'self' or 'home' measurements. To demonstrate the most appropriate term we compared self-home measurements (S-HBP), with home measurements taken by relatives (R-HBP), clinic measurements taken by physicians (P-CBP) and self-measurements in the clinic (S-CBP). PATIENTS AND METHODS: Thirty treated hypertensives were randomized to an initial clinic BP (CBP) monitoring period (week 1, P-CBP followed by S-CBP measurements, or the opposite; 1 visit each), then to a HBP monitoring period (weeks 2-3, S-HBP followed by R-HBP or the opposite; 3 workdays each), and finally to a second CBP monitoring period (week 4, S-CBP followed by P-CBP, or the opposite). Triplicate morning trough measurements were taken per occasion using the same fully automated device. RESULTS: There was no difference between S-CBP and P-CBP (mean difference -1.9 +/- 6.1 mmHg, 95% confidence interval (CI) -4.2, 0.4/-1.6 +/- 4.7, 95% CI -3.3, 0.2, systolic/diastolic), or between S-HBP and R-HBP (-0.9 +/- 6.9, 95% CI -3.5, 1.8/-0.4 +/- 4.3, 95% CI -2.0, 1.2). S-CBP was higher than S-HBP (mean difference 9.3 +/- 9.0/4.9 +/- 5.4 mmHg, systolic/diastolic, P < 0.001) and R-HBP (8.4 +/- 9.1/4.5 +/- 5.0, P < 0.001). P-CBP was also higher than S-HBP (11.2 +/- 11.9/6.5 +/- 6.8, P < 0.001) and R-HBP (10.3 +/- 11.2/6.1 +/- 6.5, P < 0.001). CONCLUSIONS: Self-measurements provide similar BP levels to measurements taken by relatives or physicians, provided that measurements are taken in the same setting. 'Self-BP' is a misnomer because self-measurement has no impact on the difference between home and clinic BP. Given that this difference can be exclusively attributed to the effect of the different setting, the term 'home BP' represents a more appropriate term.

Out-of-office blood pressure in children and adolescents: disparate findings by using home or ambulatory monitoring.

BACKGROUND: The validity of home blood pressure (HBP) measurements in children has not been evaluated, although in clinical practice such measurements are being used. This study compares HBP, with clinic (CBP) and daytime ambulatory blood pressure (ABP) in children and adolescents. METHODS: Fifty-five children and adolescents aged 6 to 18 years were evaluated with CBP (three visits), HBP (6 days), and daytime ABP. Mean age was 12.3 +/- 2.9 (SD) years, 33 boys. According to the Task Force CBP criteria, 26 were hypertensives, 6 had high-normal BP (hypertensive group), and 23 were normotensives (normotensive group). RESULTS: In the hypertensive group, CBP was 130.8 +/- 7.6/72.5 +/- 8.1 mm Hg (systolic/diastolic), HBP 118.9 +/- 6.3/73.7 +/- 6.7, and ABP 130.8 +/- 8.1/75.5 +/- 8.3. In the normotensive group, CBP was 112.8 +/- 8/63.1 +/- 6.3, HBP 106.7 +/- 8.4/67.2 +/- 5.2, and ABP 123.9 +/- 7.2/72 +/- 4.3. Strong correlations (P < .001) were observed between CBP-HBP (r = 0.73/0.57, systolic/diastolic), CBP-ABP (r = 0.59/0.49), and HBP-ABP (r = 0.72/0.66). In normotensive subjects, ABP was higher than both CBP and HBP for systolic and diastolic BP (P < .001). Furthermore, systolic HBP was lower than CBP (P < .01), whereas the opposite was true for diastolic BP (P < .05). In hypertensive subjects systolic HBP was lower than both CBP and ABP (P < .001), whereas CBP did not differ from ABP. For diastolic BP no differences were found among measurement methods. CONCLUSIONS: These data suggest that, in contrast to adults in whom HBP is close to the levels of daytime ABP, in children and adolescents HBP appears to be significantly lower than daytime ABP. Until more data become available, caution is needed in the interpretation of HBP in children and adolescents.

Office and out-of-office blood pressure measurement in children and adolescents.

Office and out-of-office blood pressure measurements are being used for the diagnosis of hypertension in children and adolescents. The US National Heart, Lung, and Blood Institute have recently presented a new classification of blood pressure. On the basis of office measurements the 90th, 95th and 99th percentile for gender, age and height are used to classify children and adolescents as normotensive, pre-hypertensive and stage-1 or stage-2 hypertensive. Although auscultation using a standard mercury sphygmomanometer remains the recommended method, accumulating evidence suggests that ambulatory blood pressure monitoring is useful for the detection of white-coat hypertension and the prediction of target organ damage in children and adolescents. Studies have shown ambulatory blood pressure to be more reproducible than office measurements and normative tables for ambulatory measurements have been developed from cross-sectional studies in children and adolescents. In regard to home measurements in children, there are limited data from small trials showing lower blood pressure levels than daytime ambulatory blood pressure. In conclusion, ambulatory blood pressure monitoring is already finding a role as a supplementary source of information in children and adolescents, whereas at present home measurements should not be used for decision making in this population.

Phase II study of gemcitabine plus docetaxel as second-line treatment in malignant pleural mesothelioma: a single institution study.

OBJECTIVE: The combinations of cisplatin-pemetrexed and cisplatin-gemcitabine are considered the standard systemic therapy for malignant pleural mesothelioma (MPM), which is a rapidly progressive tumor. The purpose of the present study is to evaluate the efficacy, safety, and clinical benefit of the gemcitabine plus docetaxel regimen in the second-line treatment of this disease. PATIENTS AND METHODS: A total of 37 patients with MPM were treated with the combination of docetaxel (80 mg/m) and gemcitabine (1000 mg/m) on day 1 and 14 of a 28-day cycle. The regimen was repeated for a maximum of 6 cycles or until disease progression or unacceptable toxicity. RESULTS: There was partial response of the disease in 7 patients (18.9%), whereas it remained stable in 23 patients (62.2%) and progressed in 7 patients (18.9%). The median time to disease progression was 7 months (range: 5.8-8.2 months) with a mean survival of 16.2 months (range: 13-19.3 months). CONCLUSION: The biweekly administration of docetaxel and gemcitabine, along with granulocyte colony-stimulating factor support, constitutes a safe, tolerable, and convenient regimen for the treatment of MPM, suggesting that this combination may be a viable option, especially in previously treated patients.

Serum bone turnover markers may be involved in the metastatic potential of lung cancer patients.

The aim of this study was to investigate several bone markers in Non-Small Cell Lung (NSCLC) and Small Cell Lung (SCLC) patients experiencing or not secondary bony disease. Fasting serum levels of bone formation, bone resorption, and osteoclastogenesis markers were determined in 22 NSCLC patients with bone metastases, 18 without bone metastasis, and 28 SCLC patients. A total of 29 healthy volunteers were also included in the study. Decreased osteocalcin (OC) serum levels and increased osteopontin and ligand of the receptor of nuclear factor kB (RANKL) serum levels were detected in NCSLC patients with bone metastases while increased C-terminal cross-linking telopeptide of type I collagen and increased RANKL/OPG (osteoprotegerin) ratio were detected in SCLC patients. Increased serum levels of OPG were observed in all lung cancer patients. OPG may be actively involved in the development of lung cancer metastasis. Furthermore, OC, OPN, and RANKL in NSCLC and CTX and RANKL in SCLC patients may also have a broader role in the pathogenesis and spread of lung cancer. They also provide useful information in identifying the group of patients that may benefit from a more rigorous treatment.

Effects of taxane-based chemotherapy on inhibin B and gonadotropins as biomarkers of spermatogenesis.

OBJECTIVE: To assess the effects of taxane-based chemotherapy on the male reproductive axis, and, therefore, its impact on spermatogenesis and fertility. DESIGN: Controlled clinical study. SETTING: Patients with cancer in an academic research environment. PATIENT(S): Forty male patients of reproductive age with cancer with solid tumor at diagnosis, who had been scheduled to receive taxane-based chemotherapy. INTERVENTION(S): The patients were given treatment with docetaxel or paclitaxel combined with gemcitabine or carboplatin. Blood sampling and testicular ultrasonography were performed before and after completion of chemotherapy. MAIN OUTCOME MEASURE(S): In all patients, serum levels of inhibin B, FSH, and LH were measured, and, in half of the patients, bilateral testicular volume was also measured. RESULT(S): There was a statistically significant decrease in serum inhibin B and increase in serum FSH in all patients after the completion of the taxane-based chemotherapy. The median LH levels did not exhibit a statistically significant increase after the last cycle. Bilateral testicular volume exhibited a statistically significant decrease in 19 out of 20 patients (95%) after completion of chemotherapy. CONCLUSION(S): Taxane-based chemotherapy induces the reduction of inhibin B and the reciprocal elevation of FSH, which are associated with significant gonadal damage in the early stages after completion of chemotherapy.

Prediction of albuminuria by different blood pressure measurement methods in type 1 diabetes: a pilot study.

In type 1 diabetes, the risk of nephropathy is strongly influenced by the level of blood pressure (BP). Ambulatory BP (ABP) monitoring has revealed an association between disturbed nocturnal BP drop and albuminuria and suggested a role of BP in microalbuminuria development. This study investigated the relationship between the urinary albumin excretion ratio (AER) and home BP (HBP) compared with ABP and clinical BP (CBP) measurements. A total of 50 adolescents and young adults with type 1 diabetes without hypertension or overt proteinuria (mean age 20+/-3.8 (s.d.) years, 21 male) had measurements of CBP (3 visits), HBP (6 days), 24-h ABP and AER (daytime and nighttime in the same 24 h with ABP monitoring). AER of 24 h was correlated with systolic 24-h (r=0.31), daytime (r=0.33) and nighttime ABP (r=0.36), without significant correlation with diastolic ABP, CBP or HBP (systolic or diastolic). Nighttime AER was correlated with 24-h (r=0.39/0.35, systolic/diastolic), daytime (r=0.36/0.32) and nighttime ABP (r=0.44/0.28). HBP was not associated with nighttime AER, but CBP was (diastolic BP only, r=0.41). No significant correlations were found between daytime AER and BP measurements. The nocturnal BP dip was not associated with any BP value. In non-dippers, nighttime AER showed strong correlations with ABP (24-h: r=0.45/0.42, systolic/diastolic; daytime: r=0.46/0.45; nighttime: r=0.49/0.35), HBP (r=0.34/0.31) and CBP (r=0.39/0.47). No such associations were found in dippers (r=0.05-0.10). These preliminary data suggest that in the early stage of diabetes-1, 24-h ABP monitoring seems to be the optimal method of revealing the association between BP and albuminuria, and cannot be replaced by HBP monitoring.

Hypersensitivity reactions to oxaliplatin: a retrospective study and the development of a desensitization protocol.

Background: We recorded the epidemiologic and clinical features of hypersensitivity reactions (HSRs) to oxaliplatin in colorectal cancer (CRC) patients in order to provide information on the management of these patients. We also developed a desensitization protocol and evaluated its clinical application. For these reasons, we analyzed retrospectively the records of 215 CRC patients treated with oxaliplatin-containing regimens either as an adjuvant, first-line, second-line, or more. Patients and Methods: Data from 52 patients with HSRs were analyzed according to the Common Toxicity Criteria for Adverse Events (CTCAE), v3.0. Three patients were chosen for the desensitization protocol. After determining the starting point for desensitization, we applied the standard protocol for parenteral desensitization to b-lactam antibiotics. Oxaliplatin treatment was then carried out with serial 10-fold dilutions in sufficient volume to administer the total dose. A total of 52 patients (24.2%) were recorded as having an allergic reaction to oxaliplatin. Results: Hypersensitivity reactions were recorded after a mean of 6.5 (SD +/- 4.5) cycles. Only 4 patients (4 of 215; 1.8%) developed CTCAE grade 3/4 HSRs. Hypersensitivity reactions were seen more likely in patients receiving second-line or more of chemotherapy compared with chemotherapy-naive patients. No other correlations were seen (the presence of atopic disease, positive skin prick test). The 3 patients, having completed the parenteral desensitization protocol, completed their treatment uneventfully as well. Conclusion: Hypersensitivity reactions from oxaliplatin respond quickly to the discontinuation of the drug and appropriate support. Premedication and an increased infusion time could allow for readministration. The desensitization protocol we developed can provide a reliable alternative to permanent discontinuation of oxaliplatin.

The use of radiolabeled somatostatin analog scintigraphy in the staging of small cell lung cancer patients.

OBJECTIVES: The prognosis of patients with small cell lung cancer (SCLC) is dismal with a median survival not exceeding 18 months. For the fact that the tumor stage remains the most significant prognostic factor, efforts have been made to improve its accuracy. We evaluated the role of somatostatin receptor scintigraphy (SRS) in the diagnosis and initial staging of SCLC in comparison with the conventional staging procedure. METHODS: We administered radiolabeled somatostatin analog Indium 111 (111In)-diethylenetriamine pentaacetic acid (also known as Indium In-111 pentetreotide or OctreoScan) in 32 newly diagnosed patients with SCLC, 19 of which of had limited disease and 13 of which had extensive disease. All patients had been previously examined with other imaging modalities, specifically CT and/or MRI. RESULTS: Staging with 111In-OctreoScan successfully located the primary tumor site with a sensitivity of 92%. Although detection of mediastinal lymph node dissemination was also relatively high (83%), the SRS failed to detect most of the metastatic lesions outside the thorax (9 of 36, 25%), while its sensitivity for the detection of malignant lesions in the liver, adrenals, and bones, was 56%, 33% and 17%, respectively. CONCLUSIONS: Although 111In-OctreoScan may be used in addition to current SCLC staging methods, there are insufficient data for maintaining that SRS may replace conventional staging.

Reproducibility of home and ambulatory blood pressure in children and adolescents.

OBJECTIVE: To evaluate the reproducibility of blood pressure measured at home (HBP) in comparison with ambulatory (ABP) and clinic blood pressure (CBP) in children and adolescents. PARTICIPANTS AND METHODS: Individuals aged 8-17 years who had been referred for elevated CBP were included. CBP was measured at two visits, HBP on 5 days and ABP for 24 h. A second session including all the above measurements was performed after 8 weeks. The reproducibility of CBP (second visit of each session), HBP (average of days 2-5 of each session) and ABP (average 24-h, awake and asleep) was quantified using test-retest correlations coefficients (r) and the standard deviation of differences (SDD) between repeated measurements. RESULTS: Sixteen individuals were included [mean age 13.3+/-2.9 (SD)] years, range 8-17, nine boys]. According to Task Force CBP criteria, eight were classified as hypertensives, three as high normal and five as normotensives. The reproducibility of HBP (systolic/diastolic r, 0.74/0.82, SDD 7.0/4.3) was superior to that of CBP (r, 0.63/0.80, SDD 10.4/6.3). However, ABP appeared to provide the most reproducible values (r, 0.87/0.84, SDD 5.5/4.3 for 24-h ABP; r, 0.85/0.76, SDD 5.9/5.0 for awake; r, 0.76/0.79, SDD 7.0/5.0 for asleep ABP). Aspects of the diurnal ABP variation were poorly reproducible (r, 0.62/0.14, SDD 6.8/5.5 for awake-asleep ABP difference; r, 0.55/0.26, SDD 0.07/0.11 for awake : asleep ratio). CONCLUSION: These data suggest that in children and adolescents home blood pressure measurements are more reproducible than clinic measurements. However, 24-h ambulatory monitoring appears to provide the most reproducible blood pressure values.