Left Ventricular Mass Index in Children with White Coat Hypertension

Abstract

Objective-To determine if children with white coat hypertension (WCH) have evidence of targetorgan damage by comparing left ventricular mass index (LVMI) of subjects with WCH to that of matched normotensive and hypertensive controls.Study design-Each WCH subject was matched by body mass index (± 10%), age (± 1 year), and sex to a normotensive control and to a hypertensive control. Echocardiograms were reviewed to determine LVMI for each subject. These triple matches were analyzed using repeated measures analysis of variance to detect differences in LVMI between the three groups.Results-Twenty-seven matched triplets were established. The groups were comparable for sex, age, and body mass index (BMI). Mean LVMI was 29.2, 32.3, and 35.1 g/m 2.7 , for normotensives, WCH, and sustained hypertensives, respectively (normotensive vs. WCH, p = 0.028; WCH vs. sustained hypertensive, p = 0.07). Left ventricular hypertrophy was not present in any subject in the normotensive or WCH groups, but was present in 26% of the sustained hypertensive subjects (p < 0.001).Conclusions-After controlling closely for BMI, children with WCH had a LVMI which was intermediate between that of normotensives and sustained hypertensives, suggesting that WCH may be associated with hypertensive end-organ effects.White coat hypertension (WCH) occurs when blood pressure is elevated in the medical office but is normal outside the office setting. In adults, there is concern that WCH may be an independent risk factor for cardiovascular disease or that it may represent a prehypertensive state, with increased risk of progression to sustained hypertension. 1 Numerous adult studies have evaluated left ventricular mass index (LVMI) in subjects with WCH. Many, but not all, Corresponding Author: Marc B. Lande, MD, 601 Elmwood Ave, Box 777, Rochester, NY 14642, Phone: 585-275-9784, Fax: 585-756-8054, Email: marc_lande@urmc.rochester.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The objective of the current study was to determine if children with WCH have evidence of hypertensive target-organ effects by comparing LVMI in children with WCH, normotension, and sustained hypertension, closely matching subjects for BMI, sex, and age. NIH Public Access MethodsThe study was performed at the University of Rochester Medical Center in Rochester, NY. At this center, ABPM has been used in the evaluation of pediatric primary hypertension since October 2002. The clinical purpose of ABPM has been primarily to differentiate between sustained hypertension and white coat hypertension. It has been our practice to obtain ech...

Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension

“…The impact of white coat hypertension on left ventricular function remains controversial. In some studies, increased left ventricular mass in patients with WCH in comparison to healthy controls was reported [5]. In this study no significant differences of shortening and ejection fraction, describing left ventricular systolic function, between analysed groups were found, which is consistent with the majority of reports [13,14,[17][18][19].…”

“…In the present study LVMI was significantly higher in hypertensive boys than in normotensive ones, while no differences were found between hypertensive and WCH-hypertensive male subgroups as well as between WCH-hypertensive boys and normotensive ones. These results are consistent with data presented in the literature on condition that their authors analysed groups consisting of males and females [13][14][15].…”

“…The prevalence of white coat hypertension in children is 44% to 88%, which is higher than in adults, in whom it ranges from 20% to 60% [3,4]. The relationship between white coat hypertension and future development of persistent hypertension remains controversial, as well as the relationship between WCH and left ventricular hypertrophy [5].…”

Pharmacologic Management of Pediatric Hypertension

“…A screening study of 5,102 children aged 10-19 years in the Houston public schools demonstrated that 4.5% of children had hypertension, and 11% with BMI greater than or equal to the 95 th percentile had hypertension [3]. A repeat study in the Houston schools of 6,790 adolescents aged [11][12][13][14][15][16][17] showed that 81.1% of children had normal BP, 15.7% had prehypertension, and 3.2% had hypertension [4].…”

“…In adults, there is evidence that WCH is a non-benign condition with high risk of progression to true hypertension; it is unknown whether this holds true for children with WCH [13,14]. While current guidelines do not recommend a diagnostic workup for children with WCH, this condition may represent an intermediate state between normal blood pressure and hypertension [1,15]. Thus, patients with WCH may benefit from modification of unhealthy lifestyle habits and monitoring for worsening hypertension.…”