Naslov
The role of ambulatory blood pressure monitoring in evaluation of children and adolescents previously diagnosed as hypertensive in primary care office

Autori
Valent Morić, Bernardica ; Đelmiš, Jasna ; Žigman, Tamara

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, prošireni sažetak, ostalo

Izvornik
Kidney and Blood Pressure research / - , 2009, 321-321

Skup
5th Cental European Meeting on Hypertension

Mjesto i datum
Zagreb, Hrvatska, 22.10.2009. - 25.10.2009

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
ABPM, hypertension, children

Sažetak
Objective: to present our experience using ambulatory blood pressure monitoring (ABPM) in children and adolescents referred to our Department because of casual BP elevation above the 95 th percentile in primary care office on at least 3 visits. Methods: we reviewed ABPM studies in 139 children. Mean patient age was 14, 14 years (4- 19 years): 94 boys (67, 63%) and 45 girls (32, 37%). After performing ABPM children were classified as having either primary hypertension (PH), secondary hypertension (SH) or white coat hypertension (WCH). When WCH was diagnosed we continued follow-up, but no further test were done. The children with hypertension underwent detailed standardized evaluation to differentiate between primary or secondary hypertension. Results: among 139 children referred to our Department by their primary health care provider 107 (76, 98%) had hypertension according to the ABPM criteria. PH was diagnosed in 89 (64, 03%) children (boys 74%, girls 26%) , SH in 18 (12, 95%) children (boys 61%, girls 39%)and WCH in 32 (23, 02%) children (boys 53%, girls 47%). In both groups, PH and SH group, hypertension was predominantly systolic: in PH 60, 67% and in SH 55, 56%. In PH group 82% children had daytime systolic BP load (DSBPL) over 25 %, 32, 5% had daytime diastolic BP load (DDBPL) over 25%, 84% had nocturnal systolic BP load (NSBPL) over 25% and 43% had nocturnal diastolic BP load (NDBPL) over 25%. In SH group 83% children had DSBPL over 25 %, 44% had DDBPL over 25%, 78% had NSBPL over 25% and 33% had NDBPL over 25%. There was no significant statistical difference in daytime and nocturnal sytolic and diastolic BP load between PH and SH group. The non-dipping phenomenon was detected in 44 (49, 44%) children with PH, in 12 (66, 66%) children with SH and in 13 (40, 62%) with WCH. The mean pulse pressure values were 60, 41 mmHg in PH group, 58, 58 mmHg in SH group and 52, 25 mmHg in WCH group. We found significant statistical difference in pulse pressure values between PH and WCH (df=55, t=6, 15, p<0, 01) and SH and WCH group (df=31, t=3, 18, p=0, 001). The target organ damage was diagnosed in 16 (17, 98%) children with PH and in 5 (27, 78%) children with SH. None of the children with WCH had target organ damage. In all 3 groups there was a high percentage of overweight and obese children: 57 (64, 04%) in PH group, 9 (50%) in SH group and 15 (46, 87%) in WCH group. Conclusions: according to our results the prevalence of primary hypertension is more common in children than it is believed, especially in adolescents. Our youngest child with PH was 5 years old. ABPM is indispensable to the diagnosis of hypertension in children. It is the only reliable method for diagnosis of WCH, thereby avoiding unnecessary and expensive further diagnostic tests. Unlike some other authors we didn’t find significant statistical difference in daytime and nocturnal sytolic and diastolic BP load between PH and SH group The non-dipping phenomenon as a predictor of cardiovascular risk was the most common in SH group, but it’s role in children is still matter of debate. The children with SH were also most likely to have target organ damage.

Izvorni jezik
Engleski

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