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White coat effect--problem of assessing its incidence and magnitude in children
Monika Pijanowska1, Małgorzata Zajaczkowska, Zbigniew Pijanowski
1Department of Pediatric Nephrology, Medical University of Lublin.
Insights
The white coat effect (WCE) in children shows varied results, with about half experiencing it. Current adult calculation methods may not suit children, suggesting a need for new approaches.
Area of Science:
- Pediatrics
- Cardiology
- Hypertension Research
Background:
- The white coat effect (WCE), an elevation in blood pressure (BP) in a clinical setting, is well-documented in adults.
- Its prevalence and calculation methods in healthy children require further investigation.
Purpose of the Study:
- To assess the incidence of WCE in healthy children.
- To evaluate the appropriateness of the standard adult method for calculating WCE magnitude in pediatric populations.
Main Methods:
- Office BP measurements and 24-hour ambulatory blood pressure monitoring (ABPM) were conducted in 59 healthy children aged 10-18 years.
- WCE magnitude was calculated as the difference between office BP and mean daytime ABPM values.
Main Results:
- WCE magnitude was negative in 49% and positive in 51% of children.
- Systolic WCE ranged from -43.79 to +44.35 mmHg (mean +1.60 mmHg); Diastolic WCE ranged from -66.14 to +48.00 mmHg (mean -1.47 mmHg).
- Mean daytime ambulatory BP levels were higher than office BP in some children, potentially due to increased physical activity.
Conclusions:
- Approximately 50% of healthy children exhibit a positive WCE.
- The standard method for calculating WCE in adults appears unsuitable for children.
- Development of a pediatric-specific WCE evaluation method is warranted.
Abstract:
The aim of this study was an attempt to assess the incidence and estimate the method of calculating the magnitude of white coat effect (WCE) in healthy children. 59 healthy children aged 10-18 years underwent office blood pressure (BP) measurement and 24-hour ambulatory blood pressure monitoring (ABPM). WCE magnitude was evaluated according to the generally accepted method, as the difference between office BP and mean daytime ambulatory BP value. WCE magnitude calculated in that way was negative in 49 % children, and positive in 51 % children. Systolic blood pressure WCE ranged from (-43.79) to (+44.35) mmHg; the mean value was (+1.60) mmHg. Diastolic blood pressure WCE ranged from (-66.14) mmHg to (+48.00) mm Hg, and the average was (-1.47) mmHg. 1. Positive WCE was observed in about 50 % of the examined children. 2. Mean daytime ambulatory BP level in children may be greater than office BP level. It may be the consequence of a higher level of physical activity in children than in adults. 3. The generally accepted method of calculating WCE magnitude in adults seems inappropriate for children. 4. Introducing a new method of evaluating WCE in children (different from that used in adults) may be worth consideration.
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