Both white coat and sustained hypertension result in decreased vasodilatory reaction to CO(2) in adolescents, suggesting involvement of the cerebral arterioles. The present study underlines the importance of early recognition and proper treatment of adolescent hypertension in order to prevent long-term cardiovascular complications.

Aim: To obtain epidemiological data on the blood pressure (BP) status of high school students and factors influencing BP. Methods: Subjects filled out a questionnaire and three repeated BP measurements were taken. All high school attending students in Debrecen (final sample n = 10,194, mean age 16.6 ± 1.0 years) participated in the study. Results: Boys had significantly higher systolic BP (+11.3 mm Hg) and diastolic BP (+2.2 mm Hg) than girls (p < 0.001). There was a positive correlation between weight and BP (r_syst = 0.42, r_diast = 0.29), height and BP (r_syst = 0.33, r_diast = 0.15), body mass index (BMI) and BP (r_syst = 0.31, r_diast = 0.27). Multiple regression was used for statistical analysis. Gender (β = 0.36), BMI (β = 0.25), hypertension of parents (father β = 0.04 and mother β = 0.02), smoking, alcohol consumption and age determined systolic outcomes in descending order. For the diastolic model, BMI remained a strong determining factor (β = 0.25) and gender was also significant (β = –0.09). Entering independents together accounted for 28.2% of the total variance in systolic and for 18.1% in diastolic BP. Conclusion: Body weight is central to determining BP. Because that is an alterable cardiovascular risk factor, we presume that lifestyle modification will not only result in reduced weight, but also in decreased BP.

Our population-based study was the first to determine the point-prevalence of adolescent hypertension in Central-Eastern Europe. Identifying and following-up cases of confirmed hypertension is inevitable to prevent or delay the manifestations of target organ damage and reduce hypertension-related mortality.

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The prevalence of adolescent hypertension is increasing. The national epidemiological study found 2.5% prevalence, while it is 4.5% according to the newest international survey. Repeated casual blood pressure measurements, but not ambulatory blood pressure monitoring is needed for the diagnosis of adolescent hypertension on the basis of the presently available European guideline. At the last decade growing evidence came into light for ambulatory blood pressure monitoring in adolescence. These data show better correlation with end-organ damages than casual measurements. In patients with hypertension diagnosed based on repeated casual blood pressure measurements, 24-hour monitoring showed normal blood pressure in 21-47%, so this is the rate of white coat hypertension. Masked hypertension can also be diagnosed with the help of this method, which has a prevalence of 7-11%. We can also get useful data for secondary forms of hypertension. Until the appearance of the new European guidelines, more frequent use of ambulatory blood pressure monitoring is affordable. The confirmation of the diagnosis based on elevated casual blood pressure data is important. Ambulatory blood pressure monitoring is suggested in cases suspicious for white coat or masked hypertension, in cases of target organ damages or therapy resistant hypertension. Before administration of pharmaceutical therapy in adolescence hypertension - according to author's opinion - ambulatory blood pressure monitoring is absolutely necessary.