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Taner S, Gezici E, Unal A, Tolunay O. The association of obesity and hyperuricemia with ambulatory blood pressure in children. Pediatr Nephrol 2024:10.1007/s00467-024-06540-0. [PMID: 39367962 DOI: 10.1007/s00467-024-06540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND Primary hypertension (HTN) in children is on the rise and linked to the childhood obesity epidemic. Recent studies support the role of hyperuricemia in the pathogenesis of HTN. With this study we intend to evaluate the effect of body mass index (BMI) and uric acid levels on daily blood pressure (BP) parameters/phenotypes and target organ damage (TOD). METHODS A mean ambulatory systolic and/or diastolic BP ≥ 95th percentile or above the adolescent cut points was defined as 'HTN'. Patients were grouped as group 1 normal weight, and group 2 overweight/obese. RESULTS Of the 140 children (89 male/51 female) with a mean age of 13.9 ± 2.6 years, 21 were overweight and 86 were obese. Mean 24-h systolic BP (SBP) and daytime SBP were higher in group 2 (p = 0.015, p = 0.011). BMI was positively correlated with 24-h SBP (r = 0.272, p = 0.001) and daytime SBP (r = 0.280, p = 0.001). Uric acid level showed a moderate correlation with daytime SBP (r = 0.311, p < 0.01). Logistical regression analysis showed that daytime SBP is independently associated with obesity (OR 7.44, 95%CI 2.7-20.6, p < 0.001) and male sex (OR 4.60, 95%CI 2.0-10.2, p < 0.001), but not uric acid. Left ventricular hypertrophy was more common in non-dippers (p = 0.044). CONCLUSIONS Male sex and BMI are independently associated risk factors for systolic BP. The association between non-dipping pattern and TOD suggests the widespread use of ambulatory blood pressure monitoring (ABPM) in childhood HT. In this paper, we could not demonstrate an independent association between uric acid and SBP. The effect of uric acid on SBP seems to be regulated by other metabolic factors in addition to uric acid.
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Affiliation(s)
- Sevgin Taner
- Adana City Training and Research Hospital, Pediatric Nephrology, Adana, Turkey.
| | - Esra Gezici
- Adana City Training and Research Hospital, Pediatrics, Adana, Turkey
| | - Asena Unal
- Adana City Training and Research Hospital, Pediatrics, Adana, Turkey
| | - Orkun Tolunay
- Adana City Training and Research Hospital, Pediatrics, Adana, Turkey
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2
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Petracco AM, Mattiello R, Bortolotto CC, Ferreira RW, Matijasevich A, de Barros FCLF, Friedrich FO, Tovo‐Rodrigues L, de Barros AJD, Santos IS. Prevalence of and Factors Associated With High Blood Pressure at 15 Years of Age: A Birth Cohort Study. J Am Heart Assoc 2023; 12:e029627. [PMID: 38014655 PMCID: PMC10727349 DOI: 10.1161/jaha.123.029627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Arterial hypertension is the greatest cause of morbidity and mortality worldwide. Our aim was to investigate the prevalence of and factors associated with high blood pressure (HBP) among adolescents. METHODS AND RESULTS The Pelotas 2004 Birth Cohort included 4231 newborns from hospital births in Pelotas, Brazil. A digital automatic OMRON sphygmomanometer (model HEM 742) was used to measure blood pressure on 3 occasions (at 6, 11, and 15 years of age). Those with blood pressure ≥95th percentile for age, height, and sex on each of the 3 occasions were considered as presenting HBP. Independent variables included family (income and history of arterial hypertension), maternal (schooling, age, pregestational body mass index, and smoking during pregnancy), and adolescent characteristics at birth (sex, skin color, gestational age, intrauterine growth, and systolic and diastolic genetic factors), and at 15 years (sleep, physical activity, sodium intake, screen time, work, body mass index, fat mass index, fat-free mass index, growth pattern, and puberty status). The prevalence of HBP (95% CI) was calculated. Crude and adjusted odds ratios (ORs) stratified by sex were obtained by logistic regression. A total of 1417 adolescents with complete information on blood pressure on the 3 occasions were analyzed. The prevalence of HBP was 3.2% (95% CI, 1.9%-4.5%) in female adolescents and 4.3% (95% CI, 2.8%-5.8%) in male adolescents. Female adolescents with a family history of arterial hypertension had a 3 times higher chance of HBP than their counterparts (OR, 3.1 [95% CI, 1.26-7.54]). In male adolescents, excessive maternal pregestational weight was associated with a 2.3-fold increase in the chance of HBP. In both sexes, excessive adolescent weight was associated with HBP (ORs, 3.5 and 5.0, for female and male adolescents, respectively). A higher fat mass index and fat-free mass index in female (ORs, 1.4 and 1.2, respectively) and male adolescents (ORs, 2.5 and 3.0, respectively) increased the chance of HBP. Among male adolescents, the chance of HBP was higher among those with rapid weight gain between 48 months and 6 years and between 6 and 11 years and rapid height gain between 6 and 11 years. CONCLUSIONS Higher fat mass in both sexes and rapid weight gain in male adolescents are risk factors for HBP in adolescents aged 15 years, potentially amenable to prevention.
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Affiliation(s)
| | - Rita Mattiello
- Postgraduate Program in EpidemiologyUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | | | | | | | | | | | | | | | - Iná S. Santos
- Postgraduate Program in EpidemiologyUniversidade Federal de PelotasPelotasBrazil
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Chung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R. Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:2280-2292. [PMID: 37737026 DOI: 10.1161/hypertensionaha.123.20967] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.
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Affiliation(s)
- Jason Chung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (J.C.)
| | - Cal Robinson
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada (C.R.)
| | - Lauren Sheffield
- Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada (L.S.)
| | - Prathayini Paramanathan
- All Saints University College of Medicine, Kingstown, Saint Vincent and the Grenadines (P.P.)
| | - Andrew Yu
- Faculty of Science, University of Alberta, Edmonton, Canada (A.Y.)
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada (S.S.)
| | - Mark Mitsnefes
- Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Department of Pediatrics and Medicine, Division of Nephrology, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada (R.S.P.)
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, United Kingdom (M.D.S.)
| | - Myanca Rodrigues
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (M.R.)
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
- University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, Canada (J.D.)
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
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Seeman T, Šuláková T, Stabouli S. Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened? Curr Hypertens Rep 2023; 25:231-242. [PMID: 37639176 PMCID: PMC10491704 DOI: 10.1007/s11906-023-01260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/29/2023]
Abstract
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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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, Charles University Prague, 2nd Medical Faculty, V Úvalu 84, 15006, Prague, Czech Republic.
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic.
| | - Terezie Šuláková
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Pediatrics, Medical Faculty, University of Ostrava, Ostrava, Czech Republic
| | - Stella Stabouli
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
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5
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Urbina EM, Daniels SR, Sinaiko AR. Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here? Hypertension 2023; 80:1572-1579. [PMID: 37278234 PMCID: PMC10524445 DOI: 10.1161/hypertensionaha.122.19455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The association between hypertension in adulthood and cardiovascular morbidity and death is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.
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Affiliation(s)
- Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati
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6
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Hill-Horowitz T, Merchant K, Reyes LC, Singer P, Dukkipati H, Frank R, Sethna CB, Basalely A. Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines. RESEARCH SQUARE 2023:rs.3.rs-3074122. [PMID: 37461555 PMCID: PMC10350113 DOI: 10.21203/rs.3.rs-3074122/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background The 2022 American Heart Association (AHA) pediatric ambulatory blood pressure monitoring (ABPM) guidelines eliminated the prehypertension phenotype and blood pressure loads in ABPM interpretation criteria. Adolescents who were prehypertensive or unclassified according to the 2014 AHA pediatric ABPM guidelines will be reclassified as having hypertension or normotension. The epidemiology and association of reclassification phenotype with target organ damage (TOD) is not yet known. Methods A single center retrospective review of adolescents ages 13-21 years old between 2015-2022 was performed. Adolescents diagnosed with prehypertension or unclassified by the 2014 AHA pediatric ABPM guidelines were reclassified by the 2022 definitions. Logistic regression models adjusted for body mass index z-score evaluated the association of reclassification phenotype with left ventricular hypertrophy (LVH). Results Among 88 adolescents with prehypertension, 68% (N = 60) were reclassified as hypertensive. The majority (58%, N = 35) of hypertensive reclassification was based on isolated nocturnal blood pressures ≥ 110/65 mmHg. Taller males were more likely to reclassify as hypertensive. Adolescents reclassified as hypertensive had a greater-than-six-fold increased odds of LVH in adjusted models [OR 6.4 95%CI 1.2-33.0, p = 0.027]. Of 40 adolescents with unclassified blood pressures, 37.5% (N = 15) reclassified to normotension. There were no significant clinical or demographic variables associated with reclassification category nor was there an association with LVH. Conclusions The new ABPM guidelines effectively reclassify adolescents who were previously prehypertensive as normotensive or hypertensive based on risk of TOD. Further studies are needed to describe the long-term outcomes of ABPM phenotypes with the implementation of these guidelines.
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7
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Martinez F, Redon J, Aguilar F, Calderon JM, Lurbe E. Persistence and determinants of blood pressure phenotypes according to office and ambulatory blood pressure measurements in youth. Hypertens Res 2023; 46:1257-1266. [PMID: 36635525 DOI: 10.1038/s41440-022-01159-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/14/2023]
Abstract
Ambulatory BP monitoring is increasingly used in children and adolescents, and the persistence of discrepant phenotypes, such as white coat or masked hypertension, is a relevant issue. The objective of this study was to assess the persistence of BP phenotypes over time and the factors related to their persistence. The study included 582 children and adolescents (9.4 ± 2.8 years of age) of both sexes (51% females) referred for routine health maintenance. Anthropometric parameters and office and 24-h ABPM measurements were obtained twice (interval 19.5 ± 6.9 months). BP classification and phenotypes were qualified using the 2016 ESH Guidelines. The correlation coefficient and kappa statistics were used to assess the persistence of phenotypes, and the related factors were evaluated using logistic regression. Based on both systolic and diastolic BP measurements, 91.6%, 16%, 17.2% and 13.7% of the subjects with true normotension, sustained HTN, white coat HTN and masked HTN, respectively, remained in the same category (overall agreement 74.2%, kappa 0.20). The multivariate model predicted the lack of persistence and correctly classified 90.3% of the subjects, with the pathological baseline BP phenotype (mainly masked HTN) being the independent variable that contributed most to the model. Excluding the phenotypes, the rest of the model explained 14% of the lack of persistence, and a high office SBP and high waist circumference were related to the lack of persistence. Furthermore, subjects who experienced an increase in their BMI z score and change in their BMI category were at risk of a lack of persistence. In conclusion, children, especially those with BP phenotypes different from true normotension, should be re-evaluated because a large percentage are likely to become normotensive.
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Affiliation(s)
- Fernando Martinez
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain.,Internal Medicine Hospital Clínico of Valencia, Valencia, Spain
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain.,CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Aguilar
- CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain.,Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - José Miguel Calderon
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Empar Lurbe
- CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain. .,Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain.
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8
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Basalely A, Hill-Horowitz T, Sethna CB. Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes. Curr Hypertens Rep 2023; 25:1-11. [PMID: 36434426 DOI: 10.1007/s11906-022-01231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights the major changes reflected in the 2022 American Heart Association (AHA) Scientific Statement on Ambulatory Blood Pressure Monitoring (ABPM) in Children and Adolescents with a specific focus on the newly defined phenotypes of hypertension and their epidemiology and associated outcomes. RECENT FINDINGS The 2022 AHA guidelines' most notable changes include the following: (1) alignment of blood pressure (BP) thresholds with the 2017 American Academy of Pediatrics (AAP) clinical practice guidelines, 2017 American College of Cardiology (ACC)/AHA hypertension guidelines, and 2016 European Society of Hypertension (ESH) pediatric recommendations; (2) expansion of the use of ABPM to diagnose and phenotype pediatric hypertension in all pediatric patients; (3) removal of BP loads from diagnostic criteria; and (4) simplified classification of new hypertension phenotypes to prognosticate risks and guide clinical management. Recent studies suggest that utilizing the 2022 AHA pediatric ABPM guidelines will increase the prevalence of pediatric ambulatory hypertension, especially for wake ambulatory hypertension in older, taller males and for nocturnal hypertension in both males and females ≥ 8 years of age. The new definitions simplify the ambulatory hypertension criteria to include only the elements most predictive of future health outcomes, increase the sensitivity of BP thresholds in alignment with recent data and other guidelines, and thus make hypertension diagnoses more clinically meaningful. This guideline will also aid in the transition of adolescents and young adults to adult medical care. Further studies will be necessary to study ambulatory BP norms in a more diverse pediatric population and evaluate the impact of these guidelines on prevalence and future outcomes.
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Affiliation(s)
- Abby Basalely
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Taylor Hill-Horowitz
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA
| | - Christine B Sethna
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA. .,Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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Miyashita Y, Hanevold C, Faino A, Scher J, Lande M, Yamaguchi I, Hernandez J, Acosta A, Weaver DJ, Thomas J, Kallash M, Ferguson M, Patel KN, South AM, Kelton M, Flynn JT. White Coat Hypertension Persistence in Children and Adolescents: The Pediatric Nephrology Research Consortium Study. J Pediatr 2022; 246:154-160.e1. [PMID: 35351534 PMCID: PMC9275430 DOI: 10.1016/j.jpeds.2022.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine whether youth with white coat hypertension on initial ambulatory blood pressure monitoring (ABPM) continue to demonstrate the same pattern on repeat ABPM. STUDY DESIGN Retrospective longitudinal cohort study of patients referred for high blood pressure (BP) and diagnosed with white coat hypertension by ABPM who had follow-up ABPM 0.5-4.6 years later at 11 centers in the Pediatric Nephrology Research Consortium. We classified ABPM phenotype using the American Heart Association guidelines. At baseline, we classified those with hypertensive BP in the clinic as "stable white coat hypertension," and those with normal BP as "intermittent white coat hypertension." We used multivariable generalized linear mixed effect models to estimate the association of baseline characteristics with abnormal ABPM phenotype progression. RESULTS Eighty-nine patients met the inclusion criteria (median age, 13.9 years; 78% male). Median interval time between ABPM measurements was 14 months. On follow-up ABPM, 61% progressed to an abnormal ABPM phenotype (23% ambulatory hypertension, 38% ambulatory prehypertension). Individuals age 12-17 years and those with stable white coat hypertension had greater proportions progressing to either prehypertension or ambulatory hypertension. In the multivariable models, baseline wake systolic BP index ≥0.9 was significantly associated with higher odds of progressing to ambulatory hypertension (OR 3.07, 95% CI 1.02-9.23). CONCLUSIONS The majority of the patients with white coat hypertension progressed to an abnormal ABPM phenotype. This study supports the 2017 American Academy of Pediatrics Clinical Practice Guideline's recommendation for follow-up of ABPM in patients with white coat hypertension.
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Affiliation(s)
- Yosuke Miyashita
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Coral Hanevold
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Anna Faino
- Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, WA
| | - Julia Scher
- University of Rochester Medical Center, Rochester, NY
| | - Marc Lande
- University of Rochester Medical Center, Rochester, NY
| | - Ikuyo Yamaguchi
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Alisa Acosta
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Jason Thomas
- Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Mahmoud Kallash
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Andrew M South
- Brenner Children's, Wake Forest School of Medicine, Winston-Salem, NC
| | - Megan Kelton
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Joseph T Flynn
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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10
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Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, Mitsnefes M, Tran A, Zachariah JP. Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e114-e124. [PMID: 35603599 DOI: 10.1161/hyp.0000000000000215] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Use of ambulatory blood pressure monitoring in children and adolescents has markedly increased since publication of the last American Heart Association scientific statement on pediatric ambulatory blood pressure monitoring in 2014. In addition, there has also been significant expansion of the evidence base for use of ambulatory blood pressure monitoring in the pediatric population, including new data linking ambulatory blood pressure levels with the development of blood pressure-related target organ damage. Last, additional data have recently been published that enable simplification of the classification of pediatric ambulatory monitoring studies. This scientific statement presents a succinct review of this new evidence, guidance on optimal application of ambulatory blood pressure monitoring in the clinical setting, and an updated classification scheme for the interpretation of ambulatory blood pressure monitoring in children and adolescents. We also highlight areas of uncertainty where additional research is needed.
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11
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Lurbe E, Redon J, Alvarez J, Grau-Pérez M, Martinez F, Mancia G. Insights From Matched Office and Ambulatory Blood Pressure in Youth: Clinical Relevance. Hypertension 2022; 79:1237-1246. [PMID: 35345885 DOI: 10.1161/hypertensionaha.122.18993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Information on the relationship between ambulatory blood pressure (ABP) and concurrently office blood pressure (BP) values in youth still suffers from limitations. We provide information on the differences between office BP and ABP, the factors related, and the clinical implications. METHODS Three thousand six hundred ninety matched measurements of office BP and ABP on the same day, from 2390 children, aged 5 to 15 years, of both sexes were eligible. Office BP was measured using an oscillometric device (Omron 705 IT) and 24-hour ABP using oscillometric SpaceLabs 90207. Average of office, 24-hour, daytime, nighttime, systolic, and diastolic BP and heart rate was calculated. BP categories according to the European guidelines and phenotype of mismatch office BP versus ABP were defined. RESULTS Both daytime systolic and diastolic BP were higher than office BP with a progressive reduction of the differences from 5 to 15 years. The office minus daytime BP differences were the largest in normotensive subjects, less at high-normal, and reversed in hypertensive ones, independently of age and weight status. White coat and masked hypertension covered no more than 13.6% at all ages. CONCLUSIONS In youth, it is inaccurate to obtain reference values for ABP by extrapolating from office BP values. The differences between office BP and ABP are minimal in children with office BP values in the range of hypertension, reinforcing the recommendation to use ABP measurement at the time to confirm hypertension.
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Affiliation(s)
- Empar Lurbe
- Pediatric Department, Consorcio Hospital General (E.L., J.A.), University of Valencia, Spain.,Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain (E.L., J.R., J.A.)
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute (J.R., M.G.-P., F.M.), University of Valencia, Spain.,Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain (E.L., J.R., J.A.)
| | - Julio Alvarez
- Pediatric Department, Consorcio Hospital General (E.L., J.A.), University of Valencia, Spain.,Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain (E.L., J.R., J.A.)
| | - Maria Grau-Pérez
- Cardiovascular and Renal Research Group, INCLIVA Research Institute (J.R., M.G.-P., F.M.), University of Valencia, Spain
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12
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Khoury M, Urbina EM. Hypertension in adolescents: diagnosis, treatment, and implications. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:357-366. [DOI: 10.1016/s2352-4642(20)30344-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
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Evolution of isolated systolic hypertension with normal central blood pressure in adolescents-prospective study. Pediatr Nephrol 2021; 36:361-371. [PMID: 32880746 PMCID: PMC7815547 DOI: 10.1007/s00467-020-04731-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/12/2020] [Accepted: 07/28/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND The clinical significance of isolated systolic hypertension with normal central blood pressure known as spurious hypertension (sHT) in adolescents and its evolution over time is not known. METHODS The aim of this study was to analyze changes in office, ambulatory blood pressure (ABPM), central systolic blood pressure (cSBP), hemodynamic parameters, and target organ damage (TOD) over a 1-year follow-up in a group of non-obese children with sHT. RESULTS Of 294 patients referred for primary hypertension, 138 patients (31 girls; 22%) had hypertension confirmed by ABPM. 48/138 (35%) patients (7 girls; 15%) were diagnosed with sHT (elevated office and ambulatory systolic BP, but normal cSBP); 43 of them (6 girls; 14%) were followed for 12 ± 3 months during non-pharmacological therapy. At baseline 7 (16%) patients had borderline values of cIMT or LVMi indicating mild TOD. After 12 months, 10/43 (3 girls; 23%) patients developed sustained HT (elevated office, ambulatory BP and cSBP), 11/43 (1 girl; 26%) maintained sHT, and 22/43 (2 girls; 51%) evolved to white coat hypertension or normotension. The cSBP values increased in 27 patients (4 girls; 63%), but the group average remained in the normal range. Prevalence of TOD did not change during observation. The multivariate regression analysis showed that the only predictor of cSBP change over time was a change in serum uric acid level. CONCLUSIONS In conclusion, after 1 year of non-pharmacological treatment, 23% of adolescents with sHT developed sustained hypertension, with the main predictor of cSBP change being the change in serum uric acid.
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Filler G, Díaz-González de Ferris ME. Automated Office Blood Pressure Measurement for the Diagnosis of Hypertension. J Pediatr 2020; 227:10-12. [PMID: 32712282 DOI: 10.1016/j.jpeds.2020.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Guido Filler
- Departments of Pediatrics, Medicine, and Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Lilibeth Caberto Kidney Clinical Research Unit, London, Ontario, Canada.
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Verghese P, Matossian D. The US Preventive Services Task Force Recommendation on Screening for Blood Pressure in Children: Increasing the Pressure to Get It Right. JAMA 2020; 324:1838-1839. [PMID: 33170227 DOI: 10.1001/jama.2020.21711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Priya Verghese
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Debora Matossian
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Abstract
PURPOSE OF REVIEW To review the haemodynamic characteristics of paediatric hypertension. RECENT FINDINGS Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children.
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Affiliation(s)
- Ye Li
- King's College London British Heart Foundation Centre, London, UK
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Emily Haseler
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, UK.
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, UK
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
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