Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic

Salice, Patrizia; Ardissino, Gianluigi; Barbier, P.; Bacà, Laura; Vecchi, Daniela Li; Ghiglia, Silvia; Colli, Anna Maria; Galli, M.; Marra, Giuseppina; Testa, Sara; Edefonti, Alberto; Magrini, Fabio; Zanchetti, Alberto

doi:10.1097/hjh.0b013e3283643361

Cited by 28 publications

(28 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The higher ambulatory BP in normotensive children is reversed when monitoring hypertensives (61), a behaviour similar to that observed in the adult population, in which the difference between office and ambulatory BP gradually diminishes the lower is office BP, until for SBP values of about 120 mmHg also in adults ambulatory becomes higher than office BP (61.62). While the higher ambulatory than office BP in normotensive children has been attributed, at least in part, to physical activity, additional reasons may reside in the different method of measuring BP (61), the algorithm used to calculate systolic and DBP from the maximal amplitude (63), and the phenomenon of regression to the mean (61 The night-to-day BP ratio represents circadian variability due to the physiological nocturnal BP fall. Blood pressure normally decreases during the night-defined as 'dipping'.…”

Section: Ambulatory Blood Pressuresupporting

confidence: 62%

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Lurbe

Agabiti‐Rosei

Cruickshank

et al. 2016

Journal of Hypertension

Self Cite

1,089

1,063

View full text Add to dashboard Cite

show abstract

Section: Ambulatory Blood Pressuresupporting

confidence: 62%

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Lurbe

Agabiti‐Rosei

Cruickshank

et al. 2016

Journal of Hypertension

Self Cite

1,089

1,063

View full text Add to dashboard Cite

show abstract

“…In this analysis, 162 pairs of duplicate OBP measurements obtained from 86 individuals showed a reasonable conformity of these oscillatory and auscultatory measurements, with oscillatory OBP overestimating systolic OBP by +1.5 mmHg and diastolic OBP by +0.8 mmHg on Bland Altman analysis. The conformity between oscillatory measurements (obtained by the same equipment used in the present study) and auscultatory measurements was also confirmed by Salice et al (15).…”

Section: Obp Measurementsupporting

confidence: 73%

Using simplified blood pressure tables to avoid underdiagnosing childhood hypertension

Sharma

Mohammed

Thomas

et al. 2015

Paediatrics &Amp; Child Health

View full text Add to dashboard Cite

T he prevalence of paediatric hypertension has significantly increased as a result of the childhood obesity epidemic (1). To evaluate for hypertension, office blood pressure (OBP) measurements are interpreted using the Task Force OBP reference thresholds (also known as the fourth report blood pressure [BP] tables) (2). One-third of children, however, with OBP-based hypertension have 'white coat' hypertension, which does not require the same treatment (3,4). In addition, OBP measurements are insensitive to masked and night-time hypertension, which can independently influence target organ damage (4,5).In clinical practice, the diagnosis of 'white coat', masked and night-time hypertension is made by 24 h ambulatory BP monitoring (ABPM) (3)(4)(5). This assessment involves specialized instrumentation (for continuous and timed ABP measurements), trained staff and costs that are nonreimbursable in many regions. Those diagnosed with OBP-based hypertension as per fourth report BP thresholds are referred for ABPM assessment (6-8).While the fourth report BP tables are widely available, two large North American studies found that hypertension remained undiagnosed by care providers in 74% to 87% of children, even though their recorded OBP exceeded fourth report OBP thresholds (9,10). This underdiagnosis of hypertension was largely due to the logistics of applying the fourth reports BP tables in clinical practice. The fourth report BP tables require a patient's height percentile to interpret his or her OBP. Height percentile is not always plotted in many patient care settings. Moreover, 476 OBP . OBP classified as abnormal by the simplified BP thresholds and by the fourth report BP thresholds performed similarly for correctly identifying abnormal ABP measurements as per ABP references (overlapping 95% CIs of the sensitivity, specificity and predictive values and likelihood ratios). CONCLUSIONS: Simplified BP tables, proposed to reduce the underdiagnosis of hypertension in children, can serve as a useful screening tool to decide a referral for ABP monitoring. Future prospective studies are needed to establish these findings.

show abstract

“…31,40 The ELSA data confirm older findings Table. by guest on May 12, 2018 http://hyper.ahajournals.org/ Downloaded from that the WC effect is progressively lower the lower office BP is, 41 as well as the results of a recent study of normotensive and hypertensive children and adolescents showing the WC effect disappears and changes sign (ABP higher than office BP) at office BP values <110 to 120/65 to 70 mm Hg. 42 They also provide, however, additional information that previous studies, being noninterventional, could not provide. In the absence of treatment the relationship of the WC effect to office BP was much steeper in WCH than in SH individuals, and only the WCH curve steepness was reduced by treatment, whereas the SH curve steepness remained substantially unmodified.…”

Section: Discussionmentioning

confidence: 64%

Effect of Long-Term Antihypertensive Treatment on White-Coat Hypertension

et al. 2014

Self Cite

View full text Add to dashboard Cite

A large number of studies has provided information on the clinical characteristics of subjects with isolated office or white-coat hypertension (WCH). [1][2][3][4][5][6][7][8][9][10][11][12][13] However, information is limited on whether and to what extent WCH is affected by antihypertensive treatment. The limitation includes the effect of treatment on blood pressure (BP) because although some studies have reported that in WCH treatment lowers office BP, 14 other studies deny that this occurs, quoting as an example the case of spurious resistant hypertension, that is, a condition in which a normal ambulatory BP (ABP) is accompanied by an office BP that remains elevated despite multiple drug treatment. 15,16 Furthermore, the effect of treatment on ABP values of WCH individuals is by no means clear because the reports range from a marked ABP fall to an ABP fall with some drugs only to no ABP fall at all. 14,[17][18][19][20][21][22][23][24][25][26][27] Previous studies on the BP effects of antihypertensive treatment in WCH have usually assessed ABP by just one 24-hour recording, sometimes without a baseline reference value.14,28 Primary aim of the present study has been to address the issue in a more adequate fashion by taking advantage of the unique data provided by the European Lacidipine Study on Atherosclerosis (ELSA) trial, 29 the only prospective antihypertensive treatment trial in which all patients with moderate elevations of both systolic BP (SBP) and diastolic BP (DBP) had office and ABP measured (1) before randomization to treatment and (2) at 6-month (office BP) and 12-month (ABP) intervals during treatment over a follow-up of 4 years. The multiple office and ABP measurements during the treatment period allowed us to more properly address also other issues relevant to WCH, such as the modification with time of the difference between office and ABP, often defined as the WC effect, 14,30 and the effect of treatment on within 24 hours and visit-to-visit BP variability (short-and long-term variability) of WCH vis-à-vis sustained hypertensive individuals. 31 These issues have never been addressed before. Methods Study Design and PatientsThe design and methods of the ELSA trial have been described in detail elsewhere. 29 Briefly, ELSA was a prospective, randomized, double-blind trial comparing the effects of long-term β-blocker or calcium antagonist treatment on the progression of carotid intimamedia thickness in mild-to-moderate essential hypertension. Randomization criteria were (1) an age between 45 and 75 years, Abstract-Limited evidence is available on the extent and frequency by which antihypertensive treatment lowers office blood pressure (BP) in white-coat hypertension (WCH). Data are even more scanty and discrepant on the corresponding effect on ambulatory BP (ABP). In the hypertensive patients of the European Lacidipine Study on Atherosclerosis (ELSA), office and ABP were measured before treatment and at 6-month (office BP) or 12-month (ABP) intervals during the 4-year administration of calcium chann...

show abstract

Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic

Cited by 28 publications

References 20 publications

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Using simplified blood pressure tables to avoid underdiagnosing childhood hypertension

Effect of Long-Term Antihypertensive Treatment on White-Coat Hypertension

Contact Info

Product

Resources

About