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'White coat' hypertension in children
J L Hornsby1, P F Mongan, A T Taylor
1Department of Family Medicine, School of Medicine, Medical College of Georgia, Augusta 30912.
Insights
White coat hypertension exists in children, differing significantly from normotensive and hypertensive children in 24-hour ambulatory blood pressure monitoring (ABPM) patterns. Heavier children face a higher risk of elevated systolic blood pressure.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Clinical Diagnostics
Background:
- Ambulatory blood pressure monitoring (ABPM) is crucial for diagnosing hypertension, particularly for identifying
- white coat
- hypertension in adults.
- The presence of
- white coat
- hypertension in children remains understudied.
- Essential hypertension has a known familial component.
Purpose of the Study:
- To determine if
- white coat
- hypertension exists in children with a family history of essential hypertension.
- To compare 24-hour ABPM patterns between normotensive,
- white coat
- hypertensive, and hypertensive children.
Main Methods:
- One hundred fifty-nine children (ages 5–15) were enrolled.
- Subjects were categorized into normotensive,
- white coat
- hypertensive, or hypertensive groups based on office and 24-hour ABPM readings.
- Office blood pressure measurements and 24-hour ABPM were utilized.
Main Results:
- Of 34 subjects with elevated systolic blood pressure (≥95th percentile), 44% were reclassified as
- white coat
- hypertensive.
- Significant differences in 24-hour ABPM patterns were observed between the normotensive,
- white coat
- hypertensive, and hypertensive groups.
- ABPM patterns of
- white coat
- hypertensive children differed significantly from normotensive children.
Conclusions:
- This study confirms the existence of
- white coat
- hypertension in children.
- Children with
- white coat
- hypertension exhibit distinct 24-hour ABPM profiles compared to normotensive and hypertensive peers.
- Increased body weight in children is associated with a higher likelihood of elevated systolic blood pressure, independent of other factors.
Background:
Research with ambulatory blood pressure monitoring (ABPM) clearly demonstrates the importance of identifying "white coat" hypertension before making the diagnosis of hypertension. While the existence of white coat hypertension has been documented in adults, it is unknown whether this phenomenon is present during childhood. Therefore, the purposes of this study were to determine whether white coat hypertension exists in children with a positive family history of essential hypertension; and if it exists, to compare 24-hour ambulatory blood pressure patterns among normotensive, white coat hypertensive, and hypertensive children.
Methods:
One hundred fifty-nine children (aged 5 to 15 years) participated in the study. Based on office systolic and diastolic measurements and 24-hour ABPM, subjects were placed into one of three groups: normotensive, white coat hypertensive, and hypertensive.
Results:
Forty-four percent of 34 subjects with systolic blood pressures greater than or equal to 95th percentile were reclassified as white coat hypertensive; 56% remained hypertensive. Group comparisons of 24-hour ABPM patterns showed significant differences between groups. Also, the ABPM patterns of white coat hypertensive patients were significantly different from those of normotensive patients.
Conclusions:
This study documented the existence of white coat hypertension in children and showed that white coat hypertensive children were significantly different from normotensive and hypertensive children on most comparisons of 24-hour ABPM data. Also, when age and sex were controlled, heavier children had a more significant chance of having elevated systolic blood pressure than normal-weight children, regardless of their race, height, or body mass index.