Ambulatory blood pressure monitoring and target organ damage in pediatrics
Stella Stabouli1, Vasilios Kotsis, Nikos Zakopoulos
1Second Department of Pediatrics, 'P. and A. Kyriakou' Children's Hospital, Greece. sstaboul@med.uoa.gr
Insights
Rising childhood obesity fuels hypertension in youth, leading to early organ damage. Ambulatory blood pressure monitoring offers more accurate diagnosis and risk assessment for pediatric hypertension, including masked hypertension.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Pediatric hypertension prevalence is increasing, linked to rising childhood obesity rates.
- Hypertension in children and adolescents is associated with early target organ damage.
- Published guidelines have improved the identification of pediatric hypertension.
Purpose of the Study:
- To review the diagnostic accuracy of ambulatory blood pressure monitoring (ABPM) for hypertension in children and adolescents.
- To evaluate the association of ABPM with target organ damage and different hypertension subtypes.
- To highlight the clinical utility of ABPM in pediatric hypertension management.
Main Methods:
- Review of current literature and published guidelines on pediatric hypertension diagnosis.
- Analysis of evidence supporting auscultation versus ABPM for hypertension detection.
- Examination of studies correlating blood pressure monitoring methods with target organ damage.
Main Results:
- Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as more accurate than traditional auscultation for diagnosing hypertension in children and adolescents.
- ABPM is more closely associated with target organ damage compared to auscultatory methods.
- ABPM is crucial for identifying white-coat hypertension and masked hypertension, which carries risks similar to established hypertension.
Conclusions:
- Ambulatory blood pressure monitoring (ABPM) is a valuable tool for accurate hypertension diagnosis in pediatric populations.
- Masked hypertension in children and adolescents poses significant risks for target organ damage, similar to overt hypertension.
- Increased utilization of ABPM can improve the management and risk stratification of hypertension in youth.
Abstract:
The prevalence of hypertension in children and adolescents is rising in association with the increasing rate of childhood obesity, and it is associated with early target organ damage. Published guidelines on high blood pressure in children and adolescents, focused on the early and accurate diagnosis of hypertension, resulted in improved ability to identify children with hypertension. Although auscultation using a mercury sphygmomanometer remains the method of choice for evaluation of hypertension in children, accumulating evidence suggests that ambulatory blood pressure monitoring is a more accurate method for diagnosis, and it is more closely associated with target organ damage. In addition, ambulatory blood pressure monitoring is a valuable tool in the assessment of white-coat hypertension, and masked hypertension in children and adolescents. Masked hypertension in children and adolescents is associated with a similar risk of target organ damage as in established hypertension.
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