Prevalence, Persistence, and Clinical Significance of Masked Hypertension in Youth

Abstract

Abstract-Masked hypertension, an elevated daytime ambulatory blood pressure in the presence of a normal office blood pressure, confers an increased cardiovascular risk to adults. We investigated the prevalence, persistence, and clinical significance of masked hypertension in children and adolescents. We enrolled 592 youths (6 to 18 years old). Youths with masked hypertension (nϭ34) and a random sample of the normotensive participants (nϭ200) were followed-up. In a nested case-control study, we compared echocardiographic left ventricular mass among cases with persistent masked hypertension and normotensive controls. At baseline, mean age was 10.2 years; 535 youths were normotensive on office and daytime ambulatory blood pressure measurement (90.4%), and 45 had masked hypertension (7.6%). Compared with normotensive controls, participants with masked hypertension had a higher ambulatory pulse rate, were more obese, and were 2.5-times more likely to have a parental history of hypertension. Among 34 patients with masked hypertension (median follow-up 37 months), 18 became normotensive, 13 had persistent masked hypertension, and 3 had sustained hypertension. Patients with persistent masked hypertension (nϭ17) or who progressed from masked to sustained hypertension (nϭ3) had a higher left ventricular mass index (34.9 versus 29.6 g/m 2.7 ; Pϭ0.023) and a higher percentage with left ventricular mass index above the 95th percentile (30% versus 0%; Pϭ0.014) than normotensive controls. In children and adolescents, masked hypertension is a precursor of sustained hypertension and left ventricular hypertrophy. This condition warrants follow-up and, once it becomes persistent, is an indication for blood pressure-lowering treatment.

Sympathoadrenergic and metabolic factors are involved in ambulatory blood pressure rise in childhood obesity

“…This proportion is definitely lower than that found by us 5 and other groups in obese children using office BP. 23 This was particularly the case in boys, given the higher prevalence of IOH in boys than in girls. Similarly, among SH subjects, the prevalence of isolated systolic hypertension, which affects 94% of American obese hypertensive children using office BP, 14 definitely decreased when considering ABP values.…”

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

“…The inverse phenomenon, masked HTN, defined as normal BP in the office but elevated BP outside the office, occurs in approximately 10% of children and adolescents (74,(77)(78)(79)(80). The persistence and clinical significance of the phenomenon has shown that in 40% of children, the abnormal elevation of the daytime ambulatory BP persisted over a minimum of 6 months (79).…”

“…Family history of HTN or CV disease may identify children and adolescents with essential HTN, but history of hereditary diseases associated with secondary forms of HTN should also be relevant (1,37). Parental history of HTN has been associated with masked HTN, early TOD, changes in central and peripheral hemodynamics, and can guide further evaluation (79,(93)(94)(95). A complete clinical history assessment may include information summaraised in Table 4.2.1.…”

Comparison of office, ambulatory and home blood pressure in children and adolescents on the basis of normalcy tables

“…1,2 As in the adults, because of the phenomena of white coat and masked hypertension, office and out-of-office BP measurement (with ambulatory monitoring or at home) is needed for the precise diagnosis of hypertension in children. [1][2][3][4][5] The recent guidelines by the European Society of Hypertension for the assessment of children and adolescents with elevated BP 1 and by the American Heart Association for the use of ambulatory BP monitoring in children 6 stated that this method is indispensable for the precise diagnosis of hypertension in children. Home BP monitoring is also being used by practitioners for the assessment of out-of-office BP in children, 7,8 yet evidence on its usefulness in the pediatric population has only recently been reported.…”