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White coat hypertension in childhood: evidence for end-organ effect

Rae-Ellen W Kavey1, Daniel A Kveselis, Nader Atallah

  • 1Division of Pediatric Cardiology, State University of New York Syracuse Health Science Center, Syracuse, NY, USA. kaveyr@nhlbi.nih.gov

The Journal of Pediatrics
|April 25, 2007
PubMed

Insights

White coat hypertension in children may indicate a prehypertensive state. Elevated exercise blood pressure and left ventricular mass index were observed in many children diagnosed with white coat hypertension, suggesting a need for further monitoring.

Area of Science:

  • Pediatric Cardiology
  • Hypertension Research
  • Clinical Diagnostics

Background:

  • High blood pressure (HBP) in children requires careful evaluation to distinguish between sustained hypertension and transient elevations.
  • White coat hypertension (WCH), characterized by elevated office blood pressure (BP) but normal readings during ambulatory monitoring, is increasingly recognized in pediatric populations.

Purpose of the Study:

  • To investigate whether white coat hypertension (WCH) in children signifies a prehypertensive condition.
  • To correlate ambulatory blood pressure monitoring (ABPM) findings with exercise BP response and left ventricular mass index (LVMI) in children with high blood pressure (HBP).

Main Methods:

  • Evaluated 119 children (age 6-18) with HBP, defined by office systolic BP exceeding the 95th percentile.
  • Classified subjects into WCH (normal awake ABPM) and HBP groups using ABPM.
  • Assessed BP response during treadmill exercise (TE) and measured LVMI via echocardiography.

Main Results:

  • Office BP did not differ between WCH and HBP groups.
  • Children with WCH showed lower awake ABPM systolic BP compared to the HBP group.
  • Exaggerated BP response during TE and/or increased LVMI were found in 62% of children diagnosed with WCH.

Conclusions:

  • The findings suggest that WCH in children may represent a prehypertensive state.
  • Elevated exercise BP and increased LVMI in WCH patients warrant further investigation and monitoring for progression to sustained hypertension.
Abstract

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