Essential Hypertension and White Coat Hypertension in Children and Adolescents

Overview

24-hour ambulatory blood pressure monitoring (ABPM) provides more accurate assessment of blood pressure(BP) in the patient’s common environment. The results of ABPM in the adult population have a much bettercorrelation with end organ damage than casual blood pressure and seem to provide more sensitive data of thegeneral prognosis in terms of morbidity and mortality. The objective of this study was to evaluate the ABPM ina setting close to a population study. 115 children and adolescents aged 8 - 20 years (82 boys and 33 girls) withrepeatedly elevated conventional BP readings in 25 primary care physicians’ and pediatricians’ offices wereincluded to participate in this study in the course of two years. Based on the results of the ABPM 51 subjects (44%)were labelled as white coat hypertension (WCH). Of 64 hypertensive subjects 7 (11%) were known to havea secondary cause of hypertension, the rest - 57 (89%) were assumed to suffer from essential hypertension. Thenocturnal dipping of blood pressure was significantly lower in hypertensive subjects when compared with WCH(the difference of systolic dipping was 2.7% on average, p = 0.003; the difference of diastolic dipping was 2.5%;p = 0.04). 24-hours pulse pressure values were significantly higher in hypertensive subjects (59.6 ± 7.3 mm Hg)compared with WCH (53.3 ± 5.3 mm Hg); p < 10 -5 . The left ventricular measurements in hypertensive subjects werehigher when compared with WCH (left ventricle posterior wall thickness 8.4 ± 1 mm in hypertensive vs. 8.0 ± 1.1 mmin WHC (p = 0.047) and left ventricular mass index 81.8 ± 13.8 g/m 2 vs. 74.3 ± 12 g/m 2 respectively; p = 0.003).

Key words:
ambulatory blood pressure monitoring (ABPM), white coat hypertension, children, hypertension,