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White coat hypertension in children
1Section of Nephrology and Hypertension, Department of Pediatrics, University of Texas - Houston School of Medicine, Houston 77030, USA. jonathan.m.sorof@uth.tmc.edu
Insights
Ambulatory blood pressure monitoring (ABPM) aids in diagnosing elevated blood pressure in children. Accurate diagnosis of white coat hypertension (WCH) in pediatric patients is crucial to avoid unnecessary invasive tests.
Area of Science:
- Pediatric Cardiology
- Clinical Diagnostics
Background:
- Ambulatory blood pressure monitoring (ABPM) is increasingly utilized for evaluating elevated blood pressure in children.
- Accurate diagnosis of white coat hypertension (WCH) in pediatric populations is critical to prevent costly and invasive investigations for underlying conditions.
Purpose of the Study:
- To highlight the importance of ABPM in pediatric hypertension assessment.
- To discuss the prevalence and diagnostic implications of WCH in children.
Main Methods:
- Review of recent pediatric normative data for ABPM interpretation.
- Analysis of existing studies on WCH prevalence in children.
Main Results:
- Recent normative data improve ABPM interpretation in pediatric patients.
- Studies indicate a high prevalence of WCH in children, ranging from 44-88% based on threshold values.
- WCH in children mirrors findings in adult populations.
Conclusions:
- ABPM is recommended for initial evaluation when persistent hypertension is confirmed.
- Further diagnostic steps for confirmed hypertension should be individualized based on patient factors like age, severity, risks, and end-organ damage.
Abstract:
Ambulatory blood pressure monitoring (ABPM) has become more widely used in the assessment of elevated blood pressure in children. The accurate diagnosis of white coat hypertension (WCH) is particularly important in children because detection of elevated blood pressure often results in expensive and invasive diagnostic procedures to detect underlying disease. Recent normative pediatric data have both enhanced our ability to interpret ABPM results in pediatric patients and increased awareness that children suffer from WCH as has already been reported in adults. The few studies of WCH in children report a prevalence ranging from 44-88%, depending on the choice of threshold values for normalcy. When persistent hypertension is confirmed by three blood pressure measurements on three different occasions, ABPM should be performed as part of the initial evaluation. If hypertension is confirmed by ABPM, further evaluation should be tailored to the individual patient depending on the age, severity of hypertension, associated risk factors, and presence of end-organ injury.