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White coat effect and white coat hypertension in pediatric patients
Seiji Matsuoka1, Ken Kawamura, Masataka Honda
1Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Insights
The white coat (WC) effect is common in pediatric patients, particularly those with higher blood pressure readings. White coat hypertension (WCH) affects nearly half of hypertensive children studied.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Ambulatory Blood Pressure Monitoring
Background:
- The white coat (WC) effect, a rise in blood pressure in a clinical setting, is recognized in adults.
- Understanding the prevalence and characteristics of the WC effect and white coat hypertension (WCH) in pediatric populations is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the prevalence of the WC effect in pediatric patients.
- To assess the prevalence of WCH among hypertensive pediatric patients.
Main Methods:
- Evaluated 206 pediatric patients (aged 6-25 years), including 136 normotensive and 70 hypertensive individuals.
- Defined hypertension based on auscultatory blood pressure measurements exceeding the 95th percentile for age and sex.
- Calculated WC effect as the difference between office blood pressure and daytime ambulatory blood pressure (ABP).
- Diagnosed WCH in hypertensive patients when daytime ABP was below the 95th percentile for sex and height.
Main Results:
- A positive correlation was found between office blood pressure and the WC effect (P<0.05).
- A WC effect of ≥10 mmHg was observed in 50% of hypertensive patients versus 25% of normotensive patients.
- Among 70 hypertensive pediatric patients, 33 (47%) were diagnosed with WCH.
- No significant differences in WCH prevalence were noted regarding age, gender, or hypertension etiology.
Conclusions:
- The white coat effect is frequently observed in pediatric patients.
- The WC effect is more prevalent in pediatric patients with higher office blood pressure readings.
- Nearly half of hypertensive pediatric patients exhibit white coat hypertension, highlighting the need for ambulatory blood pressure monitoring.
Abstract:
We evaluated the prevalence of white coat (WC) effect in pediatric age patients and that of white coat hypertension (WCH) in hypertensive pediatric patients. Two hundred and six patients (136 normotensive and 70 hypertensive patients, 107 boys and 99 girls, aged 6-25 years, mean 13.4, SD 4.7) were studied. Hypertension was diagnosed when systolic and/or diastolic blood pressure (BP) measurements with auscultatory technique were >or= the 95th percentile for sex and age. WC effect was defined as office BP minus daytime mean ambulatory BP (ABP). WCH was diagnosed in the hypertensive patients when daytime ABP values were < the 95th percentile for sex and height of reference values. There was a positive correlation between office BP and WC effect ( P<0.05). A WC effect of >or= 10 mmHg was observed more frequently in hypertensive patients (50%) than in normotensive patients (25%). Among 70 hypertensive patients, 33 (47%) had WCH. There was no significant difference in the prevalence of WCH in relation to age, gender, or the presence or absence of causes of hypertension. In conclusion, WC effect is frequently seen in pediatric patients, and is more common in subjects with higher office BP.