Ambulatory blood pressure monitoring and target organ damage in pediatrics

Stabouli, Stella; Kotsis, Vasilios; Zakopoulos, Nikos

doi:10.1097/hjh.0b013e3282775992

Cited by 76 publications

(65 citation statements)

References 117 publications

(153 reference statements)

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“…With ABPM, BP is measured in the patient's usual environment, eliminating the white coat effect and allowing assessment of circadian variability (i.e., awake vs. sleep BP) neither of which are possible with cBP measurements. ABPM is the only technique that can detect masked hypertension (normal office BP but elevated out-of-office BP), which is associated with increased cardiovascular risk and development of target-organ damage [15,22,23]. Additionally, ABPM allows estimation of the mean BP, BP load (percentage of elevated readings) and BP variability, all of which have been shown to have important prognostic implications.…”

Section: The Potential Importance Of Ambulatory Bp Monitoringmentioning

confidence: 99%

“…Additionally, ABPM allows estimation of the mean BP, BP load (percentage of elevated readings) and BP variability, all of which have been shown to have important prognostic implications. Abnormalities of ambulatory BP predict adverse cardiovascular events in adults such as myocardial infarction, stroke, and death [20], and also predict the development of hypertensive target-organ damage (e.g., left ventricular hypertrophy) in both adults [20] and children [11,15,22,23]. Given this, ABPM is superior to cBP for detecting the elevated cardiovascular risk associated with conditions such as obesity, diabetes, and CKD, and therefore would enable earlier implementation of interventions designed to reduce future cardiovascular disease.…”

Section: The Potential Importance Of Ambulatory Bp Monitoringmentioning

confidence: 99%

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Ambulatory blood pressure monitoring in children: imperfect yet essential

Flynn

2011

Pediatr Nephrol

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There has been increasing emphasis on hypertension and early cardiovascular disease in the pediatric age group over the past decade as a result of various factors, including the obesity epidemic and publication of new clinical guidelines. A key component of identifying children and adolescents with definite or potential hypertension is proper blood pressure (BP) measurement. While ambulatory blood pressure monitoring (ABPM) offers the potential for improved detection of youths at increased cardiovascular risk, it has not been widely adopted. This commentary highlights the crucial role of ABPM in the context of current trends, while at the same time identifying the current barriers to more widespread application of this technique. Chief among these is the lack of a robust, universally applicable database of pediatric ABPM normative values. Even in the absence of ideal normative data, ABPM can and should be widely applied, and a potential algorithm for such an approach is presented.Keywords Ambulatory blood pressure . Children . Adolescents . Race . Ethnicity . Practice guidelines Ambulatory blood pressure monitoring (ABPM) is not as widely used in the evaluation of pediatric patients with suspected or known hypertension as it is in adults. Why is this the case, and what is the rationale for increased application of ABPM in pediatrics? This commentary will review these issues in detail and offer a proposal for more widespread pediatric application of ABPM. Cardiovascular risk is on the rise in children and adolescentsThe epidemiology of elevated blood pressure (BP) in children and adolescents is changing. A 2004 analysis [1] of National Health and Nutrition Examination Survey (NHANES) data in the United Sates (US) demonstrated that overall BP levels in US children and adolescents have increased over the past decade: systolic BP was found to be 1.4 mmHg higher in 1999-2000 compared to 1988-1994, and diastolic BP was 3.3 mmHg higher. This increase was more pronounced in non-Hispanic black and Mexican-American children, suggesting that racial differences in BP between different racial/ ethnic groups [2] have their origins in childhood.A more recent review of BP data in 8 to 17-year-old children from the NHANES and other related populationbased studies conducted in the US from 1963 to 2002 also demonstrates an increase in the prevalence of high BP in children [3]. As illustrated in Fig. 1, the prevalence of prehypertension among all US children has now reached 10%, and the prevalence of hypertension nearly 4%. Consistent with the earlier analysis by Muntner [1], Din-Dzietham demonstrated that the recent trends in high BP have had a much greater effect on non-Hispanic blacks and Mexican-Americans than on whites [3], mirroring the increased risk of hypertension and cardiovascular disease seen among minority adults [2,4].

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Section: The Potential Importance Of Ambulatory Bp Monitoringmentioning

confidence: 99%

Section: The Potential Importance Of Ambulatory Bp Monitoringmentioning

confidence: 99%

Ambulatory blood pressure monitoring in children: imperfect yet essential

Flynn

2011

Pediatr Nephrol

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“…18 However, some studies failed to reveal an independent association of casual and/or ambulatory systolic/diastolic BP with LVMI or the presence of left ventricular hypertrophy, implying that factors such as the duration of hypertension or the characteristics of the study population (age, gender, presence of obesity or other comorbidities) may have an important role. [31][32][33] In the present study, LVM was significantly associated with systolic BP (mainly HBP and ABP and less so for CBP), nevertheless, LVMI was not significantly associated with systolic BP irrespective of the method used.…”

Section: Discussionmentioning

confidence: 99%

“…15 Reference values for ambulatory BP (ABP) in children are available 16,17 and accumulating data suggest that this method is more accurate in the diagnosis of hypertension and more closely associated with target-organ damage than the conventional clinic BP (CBP) measurements. 18 On the other hand, home BP (HBP) monitoring is regarded as an easily applicable and useful adjunct to CBP for the assessment of hypertension in adults; however data in children and adolescents are limited. 19,20 Only recently, reference HBP values in the pediatric population have been published but there is no evidence on their relationship with target-organ damage.…”

Section: Introductionmentioning

confidence: 99%

Relationship of home blood pressure with target-organ damage in children and adolescents

et al. 2011

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The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13±3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1 ± 15.1/71 ± 12.9 mm Hg (systolic/diastolic), HBP 121.3 ± 11.5/69.4 ± 6.6 mm Hg and 24-h ABP 118.9 ± 12/ 66.6 ± 6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r¼0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all Po0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r¼0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all Po0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r¼0.30 and 0.28, respectively, Po0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R 2 ¼0.22, beta ± s.e. ¼0.06 ± 0.01), whereas LVM was determined (R 2 ¼0.67) by 24-h pulse pressure (beta¼1.21±0.41), age (beta¼2.93±1.32), 24-h heart rate (beta¼À1.27±0.41) and BMI (beta¼1.78±0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.

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“…5 Masked hypertension (MH) is an elevated daytime or awake ambulatory blood pressure (BP) in the presence of a normal BP on conventional measurement at the office. [5][6][7][8] Previous studies demonstrated that MH in adults is associated with left ventricular (LV) hypertrophy 5,7,8 and a worse cardiovascular prognosis. 5,[7][8][9] Successful repair of AoC is not always associated with normalisation of the BP profile, 1,3,10 even when these patients are identified as normotensive by office BP measurement.…”

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confidence: 99%

Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function

et al. 2011

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Life expectancy is still reduced in aortic coarctation (AoC) patients despite a successful repair because of late arterial hypertension and atherosclerosis. Masked hypertension (MH) consists of an elevated daytime or awake ambulatory blood pressure (BP) in the presence of a normal BP on conventional measurement at the office. To assess the prevalence of MH among AoC normotensive young patients successfully treated and to evaluate the impact of MH on left ventricular (LV) geometry and function.We studied 76 AoC patients (mean age 14.5±5.7 years, male 64%). According to 24 h ambulatory BP monitoring (ABPM) our sample was divided in real normotensive patients (Group RN, n ¼ 40) and MH patients (Group MH, n ¼ 36). There was an increased pressure gradient in the aortic arch (15 mm Hg ± 4 vs 13 mm Hg ± 4.7, Po0.05), increased LV mass (51 g m À2.7 ±13 vs 46 g m À2.7 ±12, Po0.05), in MH AoC patients. Regional longitudinal deformation properties of the basal septal segment (À15% ± 2.4 vs À20% ± 5, Po0.01) and LV twist values (141 ± 1.6 vs 121±1.9, Po0.0001) were reduced in the MH group. There is a high prevalence of MH in young patients with repaired AoC, which is associated with abnormal LV structure and function. Clinicians should consider 24 h ABPM measurements in apparently normotensive patients followed up for AoC repair.

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Ambulatory blood pressure monitoring and target organ damage in pediatrics

Cited by 76 publications

References 117 publications

Ambulatory blood pressure monitoring in children: imperfect yet essential

Ambulatory blood pressure monitoring in children: imperfect yet essential

Relationship of home blood pressure with target-organ damage in children and adolescents

Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function

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