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Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened?
Tomáš Seeman1,2, Terezie Šuláková3,4, Stella Stabouli5
1Department of Pediatrics, Charles University Prague, 2nd Medical Faculty, V Úvalu 84, 15006, Prague, Czech Republic. tomas.seeman@lfmotol.cuni.cz.
Insights
Masked hypertension (MH), normal office BP with elevated out-of-office BP, is increasingly recognized in children. Screening is recommended for pediatric patients with hypertension risk factors or normal office BP despite suspected hypertension.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Hypertension Management
Background:
- Masked hypertension (MH) is characterized by normal office blood pressure (BP) but elevated out-of-office BP.
- First described in children in 2004, MH has garnered significant attention over the past decade.
- Understanding MH prevalence and risk factors is crucial for pediatric cardiovascular health.
Purpose of the Study:
- To review the phenomenon of masked hypertension in pediatric populations.
- To summarize current knowledge on MH prevalence, risk factors, and screening recommendations.
- To highlight the importance of out-of-office BP monitoring in children.
Main Methods:
- Literature review of studies on masked hypertension in children.
- Analysis of prevalence data across diverse pediatric cohorts.
- Synthesis of findings related to risk factors and screening strategies.
Main Results:
- MH prevalence in children varies widely (0-60%) depending on population, definition, and measurement methods.
- Highest MH prevalence observed in pediatric patients with chronic kidney disease (CKD), obesity, diabetes, and post-heart transplantation.
- In healthy children, MH prevalence is 9% with risk factors (e.g., prematurity, obesity, family history) and 0-3% without risk factors.
Conclusions:
- Masked hypertension is a significant concern in specific pediatric groups, particularly those with underlying health conditions.
- Screening for MH in healthy children should be considered for those with high-normal office BP, family history of hypertension, or normal office BP despite suspected hypertension.
- Out-of-office BP monitoring is essential for accurate diagnosis and management of masked hypertension in children.
Purpose Of Review:
The goal is to review masked hypertension (MH) as a relatively new phenomenon when patients have normal office BP but elevated out-of-office BP. Firstly, it was described in children in 2004. It has received increased attention in the past decade.
Recent Findings:
The prevalence of MH in different pediatric populations differs widely between 0 and 60% based on the population studied, definition of MH, or method of out-of-office BP measurement. The highest prevalence of MH has been demonstrated in children with chronic kidney disease (CKD), obesity, diabetes, and after heart transplantation. In healthy children but with risk factors for hypertension such as prematurity, overweight/obesity, diabetes, chronic kidney disease, or positive family history of hypertension, the prevalence of MH is 9%. In healthy children without risk factors for hypertension, the prevalence of MH is very low ranging 0-3%. In healthy children, only patients with the following clinical conditions should be screened for MH: high-normal/elevated office BP, positive family history of hypertension, and those referred for suspected hypertension who have normal office BP in the secondary/tertiary center.
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