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White-coat and masked hypertension in children: association with target-organ damage

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Abstract

White-coat hypertension (WCH) and masked hypertension have been associated with increased cardiovascular risk in adults. In the current study, we investigated: (a) the prevalence of WCH and masked hypertension in pediatric patients and (b) the association of these conditions with target organ damage. A total of 85 children underwent office blood pressure measurements, 24-h ambulatory blood pressure monitoring, echocardiography and ultrasonography of the carotid arteries. Subjects with both office and ambulatory normotension or hypertension were characterized as confirmed normotensives or hypertensives, respectively; WCH was defined as office hypertension with ambulatory normotension and masked hypertension as office normotension and ambulatory hypertension. WCH was found in 12.9% and masked hypertension in 9.4% of the subjects. WCH was significantly more prevalent in obese subjects, while masked hypertension was only present in non-obese ones. Confirmed and masked hypertensives had significantly higher left ventricular mass index than confirmed normotensives (34.0±5.8 g/m2.7, 31.9±2.9 g/m2.7 and 25.3±5.6 g/m2.7, respectively, P<0.05). White-coat hypertensives tended to have higher left ventricular mass index than confirmed normotensives, but the difference was not statistically significant (27.8±5.1 g/m2.7 versus 25.3±5.6 g/m2.7). No significant differences were found in the intima-media thickness of the carotid arteries between confirmed normotensives, white-coat hypertensives, masked hypertensives and confirmed hypertensives. WCH and masked hypertension are common conditions in children. Confirmed and masked hypertension in pediatric patients are accompanied by increased left ventricular mass index.

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References

  1. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ (2004) Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 113:475–482

    Article  PubMed  Google Scholar 

  2. American Academy of Pediatrics, National High Blood Pressure Educational Program Working Group on High Blood Pressure in Children and Adolescents (2004) The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics 114:555–576

    Article  PubMed  Google Scholar 

  3. American Academy of Pediatrics, National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 98:649–658

    PubMed  Google Scholar 

  4. Sorof JM, Cardwell G, Franco K, Portmann RJ (2002) Ambulatory and left ventricular mass index in hypertensive children. Hypertension 39:903–908

    Article  CAS  PubMed  Google Scholar 

  5. Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, Batlle D (2002) Increase in nocturnal blood pressure and progression to microalbuminuria in type I diabetes. N Engl J Med 347:797–805

    Article  CAS  PubMed  Google Scholar 

  6. Matsuoka S, Kawamura K, Honda M, Awazu M (2002) White coat effect and white coat hypertension in pediatrics patients. Pediatr Nephrol 17:950–953

    Article  PubMed  Google Scholar 

  7. Sorof JM, Portman RJ (2001) Ambulatory blood pressure measurements. Curr Opin Pediatr 13:133–137

    Article  CAS  PubMed  Google Scholar 

  8. Matsuoka S, Awazu M (2004) Masked hypertension in children and young adults. Pediatr Nephrol 19:651–654

    Article  PubMed  Google Scholar 

  9. Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, Valagussa F, Bombelli M, Giannattasio C, Zanchetti A, Mancia G (2001) Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: Data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation 104:1385–1392

    CAS  PubMed  Google Scholar 

  10. Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB (1999) Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 131:564–1572

    CAS  PubMed  Google Scholar 

  11. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2000) CDC growth charts for the United States: methods and development. Vital Health Stat 11 246:1–190

    Google Scholar 

  12. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (2002) German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: normalized references values and role of body dimensions. J Hypertens 20:1995–2007

    Article  PubMed  Google Scholar 

  13. Sahn PS, De Maria A, Kisslo J, Weyman A (1978) The Committee on the M-mode standardization of the American Society of Echocardiography results of a survey of echocardiographic measurements. Circulation 58:1072–1083

    CAS  PubMed  Google Scholar 

  14. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy. Comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  CAS  PubMed  Google Scholar 

  15. Daniels SR, Kimball TR, Morrison JA, Khoury P, Meyer RA (1995) Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 76:699–701

    Article  CAS  PubMed  Google Scholar 

  16. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, Alderman MH (1992) Left ventricular mass and body size in normotensives children and adults: assessment of allometric relations and impact of overweight. Am J Cardiol 20:1251–1260

    Google Scholar 

  17. Zakopoulos N, Papamichael C, Papaconstantinou H, Dubbins PA, Burrell CJ, Lekakis J, Stamatelopoulos S, Moulopoulos S (1999) Isolated clinic hypertension is not an innocent phenomenon: effect on the carotid artery structure. Am J Hypertens 12:245–250

    Article  CAS  PubMed  Google Scholar 

  18. Gustavsen PH, Hoegholm A, Bang LE, Kristensen KS (2003) White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. Hum Hypertens 17:811–817

    Article  CAS  Google Scholar 

  19. Sorof JM, Poffenbarger T, Franco K, Portman R (2001) Evaluation of white coat hypertension in children: importance of the definitions of normal ambulatory blood pressure and the severity of casual hypertension. Am J Hypertens 14:855–860

    Article  CAS  PubMed  Google Scholar 

  20. Muscholl MW, Hense HW, Brockel U, Doring A, Riegger GA, Schunkert H (1998) Changes in left ventricular structure and function in patients with white coat hypertension: cross sectional survey. BMJ 317:565–570

    CAS  PubMed  Google Scholar 

  21. Karter Y, Curgunlu A, Altinisik S, Erturk N, Vehid S, Mihmanli I, Ayan F, Kutlu A, Arat A, Ozturk E, Erdine S (2003) Target organ damage and changes in arterial compliance in white coat hypertension. Is white coat innocent? Blood Press 12:307–313

    Article  CAS  PubMed  Google Scholar 

  22. Muldoon MF, Nazzaro P, Sutton-Tyrrell K, Manuck SB (2000) White-coat hypertension and carotid artery atherosclerosis: a matching study. Arch Intern Med 160:1507–1512

    Article  CAS  PubMed  Google Scholar 

  23. Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N (2005) Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension 45:602–607

    Article  CAS  PubMed  Google Scholar 

  24. Ormezzano O, Baguet JP, Francois P, Quesada JL, Pierre H, Mallion JM (2004) Is there any real target organ damage associated with white-coat normotension? Clin Auton Res 14:160–166

    Article  PubMed  Google Scholar 

  25. Pickering TG, Davidson K, Gerin W, Schwartz JE (2002) Masked hypertension. Hypertension 40:795–796

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Second Department of Pediatrics, “P. and A. Kyriakou” Children’s Hospital, National and Kapodestrial University of Athens, Greece

    Stella Stabouli & Andreas Constantopoulos

  2. Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodestrial University of Athens, Greece

    Vasilios Kotsis, Savvas Toumanidis, Christos Papamichael & Nikos Zakopoulos

  3. 4 Viotias Street, 16232 , Athens, Greece

    Stella Stabouli

Authors
  1. Stella Stabouli
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  2. Vasilios Kotsis
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  3. Savvas Toumanidis
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  4. Christos Papamichael
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  5. Andreas Constantopoulos
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  6. Nikos Zakopoulos
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Correspondence to Stella Stabouli.

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Stabouli, S., Kotsis, V., Toumanidis, S. et al. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 20, 1151–1155 (2005). https://doi.org/10.1007/s00467-005-1979-5

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  • DOI: https://doi.org/10.1007/s00467-005-1979-5

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