Diagnosis of Pediatric Hypertension: European Society of Hypertension-Recommended 24-Hour vs. 24-Hour-Day–Night Ambulatory Blood Pressure Thresholds

2020 ◽  
Author(s):  
Ajay P Sharma ◽  
Kambiz Norozi ◽  
Michael Grattan ◽  
Guido Filler ◽  
Luis Altamirano-Diaz
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Ambulatory Blood Pressure ◽  
European Society ◽  
Tertiary Care ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pediatric Hypertension ◽  
Fourth Report ◽  
The Impact

Abstract Background The impact of diagnosing pediatric hypertension based on all three-24-hour, day and night ambulatory blood pressure (ABP) thresholds (combined ABP threshold) vs. conventionally used 24-hour ABP threshold is not known. Methods In this cross-sectional, retrospective study from a tertiary care outpatient clinic, we evaluated the diagnosis of hypertension based on the 24-hour European Society of Hypertension (ESH) and combined ESH ABP thresholds in untreated children with essential hypertension. The American Academy of Pediatrics (AAP) and Fourth Report thresholds were used to classify office blood pressure (OBP). Results In 159 children, aged 5–18 years, the 24-hour ESH and combined ESH thresholds classified 82% (95th confidence interval (CI) 0.68, 0.97) ABP similarly with the area under the curve (AUC) of 0.86 (95th CI 0.80, 0.91). However, the AUC of the 2 ABP thresholds was significantly higher in the participants with office hypertension than office normotension, with OBP classified by the AAP (AUC 0.93, 95th CI 0.84, 0.98 vs. 0.80, 95th CI 0.71, 0.88) or Fourth Report (AUC 0.93, 95th CI 0.83, 0.98 vs. 0.81, 95th CI 0.73, 0.88) threshold. With OBP classified by the either OBP threshold, the combined ESH threshold diagnosed significantly more masked hypertension (MH) (difference 15%, 95th CI 4.9, 24.7; P = 0.00); however, the diagnosis of white coat hypertension (WCH) by the 2 ABP thresholds did not differ significantly (difference 4%, 95th CI 1.8, 10; P = 0.16). Conclusions In children with essential hypertension, the 24-hour and combined ESH thresholds have a stronger agreement for diagnosing WCH than MH.

Abstract P222: Impact Of Adverse Childhood Experiences On Ambulatory Blood Pressure Profiles In Adolescence

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Cailin E Kellum ◽  
Paige Perry ◽  
Keri Kemp ◽  
Alan K Johnson ◽  
David M Pollock ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Adverse Childhood Experiences ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Cvd Risk ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Increased Risk ◽  
Physical Neglect

Adverse childhood experiences (ACEs) include exposure to abuse (verbal and physical), neglect, and household dysfunction during childhood. ACEs have long-lasting health impacts including increased risk for cardiovascular disease (CVD) and hypertension in adulthood. However, it is not clear how ACE exposure impacts CVD risk earlier in the life course, particularly in adolescence. To address this gap in knowledge, in this study we hypothesized that ACE exposure is associated with abnormal ambulatory blood pressure (ABP) profiles in adolescents, with an increased incidence of ambulatory hypertension phenotypes that have normal casual clinic BP [e.g., masked hypertension (MH) or blunted nocturnal dipping (BND)]. We utilized 24-h ambulatory BP monitoring (ABPM; Spacelabs) and casual clinic BP to construct a profile of adolescents with and without ACEs. Abnormal ABP profiles included the following categories: ambulatory hypertension (AH, elevated ABP and casual clinic BP ≥95 th percentile for age, sex, and height), white-coat hypertension (WCH, elevated casual clinic BP with normal ABP), MH (normal casual clinic BP with elevated ABP), or BND (drop in ABP < 10% during sleep). This study included 78 male and female adolescents (median age=16) recruited from Children’s of Alabama Pediatric Clinics. Exclusion criteria included known CVD and antihypertensive medication. Participants recorded wake and sleep times in a diary. Based on the ACE questionnaire, 51 (65%) of adolescents experienced at least 1 ACE. The prevalence of abnormal ABP profiles was similar between the group with ACE exposures vs. the group without ACE exposures (34% vs. 36%; P =0.87). In participants with ACE exposure (n=51), 9% had AH, 6% had MH, 19% had WCH, 43.1% had systolic BND and 22% had diastolic BND. In participants without ACEs (n=27), 4% had AH, 4% had MH, 29% had WCH, 37% had systolic BND and 15% had diastolic BND. Further analysis with covariates are necessary. These results suggest that adolescents with ACEs have similar prevalence of abnormal ABP overall, but higher prevalence of individual ABP phenotypes such as AH, MH, and BND compared to adolescents without ACEs.

scholarly journals Ambulatory blood pressure monitoring in young adults with different levels of office blood pressure

2018 ◽  
Vol 24 (4) ◽  
pp. 427-434
Author(s):  
N. T. Vatutin ◽  
E. V. Sklyannaya
Keyword(s):  
Blood Pressure ◽  
Young People ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Office Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring ◽  
Group 2

Objectiveof our study was to assess the ambulatory blood pressure monitoring (ABPM) in young people with different office blood pressure (BP).Design and methods. We included 981 students of a medical university at the age of 20–29 years (536 men, 445 women). ABPM was performed using the device “Kardiotekhnika 4000” (Inkart, Russia), the data were processed using the program “KT Result2” (Inkart, Russia).Results. The optimal BP during office measurement was recorded in 220 patients (22,4 %, group 1), normal — in 488 (49,8 %, group 2), high normal — in 134 (13,6 %, group 3), hypertension (HTN) 139 (14,2 %, group 4). The proportion of males was significantly higher in groups 3 and 4 (96,6 % and 85,6 %) compared with groups 1 and 2 (47,7 % and 40,2 %, respectively, p < 0,001). The median systolic BP (SBP) was 123 (110; 126) mm Hg, diastolic BP (DBP) — 85 (84; 87) mm Hg. According to the ABPM, the parameters of SBP and DBP correlated with the corresponding office BP parameters. A strong direct correlation was found for both SBP (rs= 0,87) and DBP (rs= 0,85). Daytime variability of SBP was significantly higher in individuals with high normal BP and HTN (15,9 ± 2,6 and 17,2 ± 4,2 mm Hg) compared to groups 1 and 2 (9,2 ± 4,4 and 9,9 ± 3,0, respectively, p < 0,05). The majority of young people had normal BP decrease at night (dipper), non-dipper profile was also frequent. Over-dipper and night-peaker profiles were rarely recorded. In the groups 3 and 4, a larger number of non-dipper patients were observed compared with groups 1 and 2 (23,9 % and 34,6 %, compared with 10,0 % and 11,1 %, respectively, p < 0,001). The prevalence of white-coat hypertension (WCH) among the young people was 0,31 % (95 % CI 0,06–0,75 %), among subjects with office HTN 2,2 % (95 % CI 0,4–5,3 %). The prevalence of masked hypertension (MHTN) in the studied population was 1,4 % (95 % CI 0,8–2,3 %), among normotensive subjects — 1,7 % (95 % CI 0,9–2,6 %), among subjects with high normal BP — 10,4 % (95 % CI 5,8–16,2 %).Conclusions. ABPM in young hypertensive patients is characterized by higher variability of daytime SBP. The majority (56,1 %)of HTN subjects had normal BP decrease at night. The prevalence of WCH among young people is 0,31 % (95 % CI 0,06–0,75 %). The prevalence of MHTN among young people is 1,4 % (95 % CI 0,8–2,3 %).

scholarly journals Office and Ambulatory Arterial Hypertension in Highlanders

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1962-1970
Author(s):  
Grzegorz Bilo ◽  
Lorenzo Acone ◽  
Cecilia Anza-Ramírez ◽  
José Luis Macarlupú ◽  
Davide Soranna ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Blood Oxygen Saturation ◽  
Chronic Mountain Sickness ◽  
Nocturnal Hypertension ◽  
Mountain Sickness

Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.

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