Sexual Dimorphism in the Transition From Masked to Sustained Hypertension in Healthy Youths

Abstract

C linicians who care for children and adolescents are now facing changes in hypertension, which include new methods for measuring blood pressure (BP) and assessing associated cardiovascular risk factors and target organ damage. Although conventional BP should be used as a reference method for measuring BP and diagnosing hypertension, ambulatory BP monitoring (ABPM) has been introduced into the pediatric population. According to European and American recommendations, ABPM is now increasingly recognized as being a valuable tool in the diagnosis and management of hypertension in children and adolescents.1-3 Longitudinal studies with repeated measurements have shown that ABPM is prognostically useful for some pathological conditions. 4,5 The potential role of ABPM in the identification of children who are at greatest risk to develop hypertension, for whom targeted prevention programs are expected to be most beneficial, has not been assessed.Masked hypertension, elevated ambulatory BP in the presence of normal conventional BP, is a condition that, in adults, has been associated with organ damage 6 and cardiovascular risk, similar to that for sustained hypertension (both conventional and ambulatory hypertension).7-9 In childhood, masked hypertension has received little attention, despite a prevalence of ≈10%; it persists in 40% of the subjects and has been associated with left ventricular hypertrophy. [10][11][12][13] If an elevation in ambulatory BP precedes the development of sustained hypertension, further knowledge of the risk factors associated with this BP increase can be valuable in the management of hypertension in children and adolescents. To address this issue, we performed a long-term follow-up study assessing how sustained hypertension develops over time in healthy, masked hypertensive youths. The potential sex dimorphism in the incidence and timing of the development of hypertension has been analyzed. MethodsThis is an extension of a previous follow-up report 12 starting in November 1990 with a total of 10 617 person-months. We enrolled Abstract-The risk and factors related to the development of hypertension among healthy youths with elevated ambulatory and normal conventional blood pressure, masked hypertension, have not been established. We performed a long-term follow-up study assessing how hypertension develops over time in healthy, masked hypertensive youths. The potential sex dimorphism in the incidence and timing of the development of hypertension has been analyzed. In a long-term followup study (median follow-up, 36 months), we enrolled 272 healthy conventional normotensive youths (aged 6-18 years; 55.8% girls) of whom 39 had masked hypertension at baseline. Development of sustained hypertension (hypertension in both conventional and ambulatory measurement) was recorded. The daytime systolic blood pressure increased from baseline to last available follow-up in boys (3.5 mm Hg; P<0.001) but not in girls (0.7 mm Hg; P=0.23), leading to a significant between-sex difference (P=0.0022). The incidence o...

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

“…In a general population of adolescents, 10-19 years, the rate of progression from normotension to HTN was 0.4/100 subjects/year, and among those who had high-normal BP it was 1.1/100 subjects/year (42). In another study on normotensive children with a mean follow-up of 35 months, the incidence of sustained HTN was 0.6/100 subjects/year (43). In the same study, masked hypertensive subjects had an incidence of sustained HTN of 7/100 subjects/year, the risk being higher in boys than in girls (43).…”

“…In another study on normotensive children with a mean follow-up of 35 months, the incidence of sustained HTN was 0.6/100 subjects/year (43). In the same study, masked hypertensive subjects had an incidence of sustained HTN of 7/100 subjects/year, the risk being higher in boys than in girls (43). The incidence in adolescents with T2D was estimated as 4/100 subjects/year (44).…”

“…Masked HTN has been linked with progression to HTN in youth, with the risk being higher in boys than in girls (43). Masked HTN warrants follow-up, and if it persists, left ventricular mass (LVM) should be assessed.…”

“…Sodium nitroprusside and labetalol are the most commonly used drugs for hypertensive 43 emergencies in children. However, some drugs are no longer available in some countries.…”

White-coat hypertension and masked hypertension: an update

“…73 Further, Lurbe and colleagues, in a cohort of 272 subjects aged 6-18 years showed that subjects with MHT (n=39) presented a higher risk of sustained hypertension during time, and this risk was higher in male patients. 74 Although clinic BP is in the normal range in subjects with MHT, optimal values (<120/80 mmHg) are related to a lower prevalence of this alteration with a lower presence of TOD 75 and also with a lower incidence of MHT during a long follow-up period. 76 However, this cut-off value lead to an high false-positive rate.…”