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Abstract

Ambulatory blood pressure monitoring (ABPM) has demonstrated a high prevalence of white coat hypertension (WCH) in adults, but few studies exist in obese and overweight children and adolescents. We can define WCH as elevated casual blood pressure (BP) with normal 24-hr mean BP, but ABPM in adults has shown that BP load( % of BP readings > 95th percentile) is better to predict hypertensive end-organ injury than mean BP. Our objective was to evaluate the prevalence of hypertension (HTN) and WCH in overweight and obese children and adolescents by both mean BP criteria and BP load criteria. From January 1999 to June 2000, 39 patients ( 22M/17F) from 10 to 17 years old were evaluated and in all, ABPM were performed. They were evaluated by two cardiologists and the BP was measured two times by each one, with 5 minutes interval. HTN were considered when the average of these 4 measures (systolic or diastolic) > 95th percentile. In relation to ABPM, BP was measured 3 times/hr from 8 am to 10 pm and 2 times/hr from 10 pm to 8 am. Wake and sleep period were defined by patient self-report. WCH was defined by mean BP criteria as wake systolic BP (SBP) and diastolic BP (DBP) < 95th percentile (Task Force for HTN Control in Children and Adolescent) and by BP load criteria as 24-hr SBP and DBP load < 30% (using 24-hr 95th percentile normative pediatric ABPM data). The criteria used for overweight and obesity were defined by body mass index (BMI) according to Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Service. The prevalence of HTN was 28.2% (11/39), being 54.6% females (6/11) and 90.9% (10/11) were obese. The prevalence of WCH defined by mean BP criteria was 45.4% (5/11) and 80% were girls (4/5) and 80% (4/5) were obese. BP load was normal (< 30%) in 27.2% (3/11) for SBP and 81.8% (9/11) for DBP. The prevalence of WCH by BP load criteria (SBP and DBP < 30%) was 27.2% (3/11), being 66.6% girls (2/3) and 66.6% obese (2/3); 27.2 % (3/11) of patients had WCH by both criteria (mean BP and BP load). The HTN and WCH in obese and overweight children and adolescents are common and they occur more often in girls and obese. ABPM should be used in hypertensive obese and overweight children to avoid mistaken for casual HTN that may lead to unnecessary use of medication and expensive diagnostic approaches.

white coat hypertension, ABPM, children hypertension
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© American Journal of Hypertension, Ltd. 2001
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