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White coat hypertension in children with elevated casual blood pressure
1Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, School of Medicine, University of Texas-Houston, 77030, USA.
Insights
Ambulatory blood pressure monitoring (ABPM) helps identify white coat hypertension (WCH) in children. Many referred for high blood pressure actually have WCH, avoiding unnecessary treatments.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Hypertension Research
Background:
- Pediatric hypertension is a growing concern.
- Differentiating true hypertension from white coat hypertension (WCH) is crucial for appropriate management.
- Ambulatory blood pressure monitoring (ABPM) is a valuable tool in this differentiation.
Purpose of the Study:
- To determine the frequency of pediatric white coat hypertension (WCH) in children referred to a hypertension clinic.
- To evaluate the utility of ABPM in diagnosing WCH in this population.
Main Methods:
- Reviewed data from children referred to a hypertension clinic who underwent ABPM.
- Defined WCH using three distinct criteria involving mean 24-hour blood pressure (BP) and BP load.
- Analyzed BP values against Task Force criteria and pediatric normative data.
Main Results:
- Of 51 children with confirmed clinic hypertension, WCH frequencies were 53%, 45%, and 22% based on the applied criteria.
- Elevated BP load was observed in 52% of patients with normal mean 24-hour BP.
- A significant proportion of referred children exhibited WCH.
Conclusions:
- Many children referred for elevated casual BP readings have WCH, even with strict diagnostic criteria.
- ABPM is effective in distinguishing WCH from persistent hypertension in pediatric patients.
- Accurate diagnosis with ABPM can prevent unnecessary interventions and guide timely management.
Objective:
We reviewed our experience using ambulatory blood pressure monitoring (ABPM) in children referred to a hypertension clinic to determine the frequency of pediatric white coat hypertension (WCH).
Study Design:
WCH was defined by 3 different diagnostic criteria: (1) mean 24-hour blood pressure (BP) less than Task Force-defined 95th percentile, (2) mean 24-hour BP less than 95th percentile from pediatric normative ABPM data, and (3) mean 24-hour BP less than ABPM 95th percentile and BP load (percentage of BP readings during 24-hour period exceeding the 95th percentile) less than 25%.
Results:
Clinic BP values were available in 67 otherwise healthy children who underwent ABPM; 51 had confirmed clinic hypertension by Task Force criteria. WCH frequency in these 51 patients with the stated criteria was 53%, 45%, and 22%, respectively. Elevated BP load was found in 52% (12/23) of patients with normal mean BP.
Conclusion:
These results suggest that many children referred for casual BP elevation have WCH even by strict diagnostic criteria. ABPM may help differentiate WCH from persistent hypertension, thereby avoiding unnecessary diagnostic evaluation and identifying children most likely to benefit from early intervention.