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White coat hypertension and left ventricle geometry in childhood
Serap Ata1, Duygu Övünç Hacıhamdioğlu2, Deniz Cihan3
1Department of Pediatrics, Ümraniye Training and Research Hospital, Istanbul, Türkiye.
Insights
White-coat hypertension (WCH) is linked to abnormal heart geometry in normal-weight children, indicating an intermediate cardiovascular risk. This highlights the need for monitoring WCH in this population.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Health
- Hypertension Research
Background:
- White-coat hypertension (WCH) is a condition where blood pressure is elevated in a clinical setting but normal otherwise.
- The relationship between WCH and cardiac structural changes, specifically left ventricular geometry, in children is not well-established.
- Obesity is a known risk factor for cardiovascular disease, but the impact of WCH on cardiac geometry in both obese and normal-weight children requires investigation.
Purpose of the Study:
- To investigate the association between white-coat hypertension (WCH) and left ventricular geometry abnormalities in children.
- To compare the prevalence of abnormal left ventricular geometry in normal-weight and obese children with hypertension, WCH, and normotension.
- To determine if WCH represents an intermediate cardiovascular risk state in pediatric populations.
Main Methods:
- A retrospective, single-center study involving children categorized into obese and normal-weight groups.
- Participants included children with hypertension, WCH, and normotensive controls.
- Echocardiography and ambulatory blood pressure monitoring were used to assess cardiac structure and blood pressure patterns.
Main Results:
- In normal-weight children, abnormal left ventricular geometry prevalence increased significantly with the severity of hypertension, from 1% in controls to 9.4% in WCH and 25.8% in hypertension.
- In obese children, abnormal left ventricular geometry was prevalent across all groups (19.3% to 45.8%) but did not show a progressive increase with blood pressure phenotype severity.
- The prevalence of abnormal left ventricular geometry was significantly higher in normal-weight children with WCH compared to controls.
Conclusions:
- White-coat hypertension (WCH) is associated with abnormal left ventricular geometry in normal-weight children, suggesting it may be an intermediate cardiovascular risk marker.
- The findings underscore the importance of identifying and monitoring WCH in normal-weight children for preventive cardiology.
- Further research in larger, longitudinal cohorts is needed to elucidate the interaction between WCH and obesity on cardiovascular outcomes.
Purpose:
It is not clear whether white-coat hypertension (WCH) is related to the development of left ventricular geometry changes in children.
Materials And Methods:
This retrospective, single-centre study categorised patients into obese and normal-weight groups. The obese cohort comprised 72 with hypertension (48 male, 12.3 ± 3.2 years), 40 with white-coat hypertension (WCH; 29 male, 12.9 ± 2.8 years) and 31 normotensive controls (18 male, 11.9 ± 2.2 years). The normal-weight cohort included 62 with hypertension (40 male, 12.9 ± 3.9 years), 32 with WCH (21 male, 12.5 ± 3.3 years) and 89 normotensive controls (60 male, 13.0 ± 2.1 years). Echocardiography and ambulatory blood pressure monitoring were performed for all participants with WCH or hypertension. Abnormal left ventricular geometry was defined as the presence of concentric remodelling, concentric left ventricular hypertrophy (LVH), or eccentric LVH.
Results:
The prevalence of abnormal left ventricular geometry demonstrated a significant, stepwise increase from the control group to the WCH and hypertension groups among normal-weight children (1%, 9.4% and 25.8%, respectively; p < .001). This graded trend was absent in children with obesity, where the prevalence was elevated across all groups but did not increase progressively with the severity of the blood pressure phenotype (19.3%, 15% and 45.8%, respectively; p = .002).
Conclusion:
These findings suggest that WCH may signify an intermediate cardiovascular risk state even in the absence of obesity. From a preventive medicine perspective, the identification of WCH in normal-weight children warrants periodic blood pressure monitoring. While our study clearly establishes the presence of this association in normal-weight youth, the specific nature of the interaction between WCH and obesity - whether additive or synergistic - warrants further investigation in larger, longitudinal cohorts.
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