Öz

Objective: Ambulatory blood pressure monitoring (ABPM) is the preferred method for diagnosis of hypertension(HT) in children. Here, we aimed to demonstrate the reasons for ABPM application and incidence of HT, white coat and masked HT in our cohort besides the evaluation of dipping status, biochemical and radiological parameters between the patients with normotension, elevated blood pressure(EBP) and HT.

Material and Methods: Twenty-four hour ABPM results of children followed at department of pediatric nephrology and whose office blood pressure measurements revealed HT or EBP and ABPM records of normotensive patients having chronic kidney disease or renal anomalies were evaluated retrospectively. Twenty-four hour ABPM SD score ≥1.96 defined HT while the value between 1.64 and 1.95 indicated EBP. In addition to assessment of blood pressure loads and nocturnal dipping; age, gender, body mass index(BMI), proteinuria, kidney function tests and ultrasound of urinary system were also assessed.

Results: Although ABPM was applied to total of 244 patients, 189 of them were included in the study. High casual blood pressure measurements in 108 (57.1%) asymptomatic patients constituted the major group for ABPM application. Total of 57 patients (30.2%) were normotensive, 18 (9.5%) with EBP and 114 (60.3%) were hypertensive. No difference was found in regards of BMI, proteinuria, serum creatinine levels and sonographic results between the groups. Patients with HT and EBP had significantly lower nocturnal dip than normotensive group (p<0.001). However there was no difference in number of patients with inadequate nocturnal fall in all three groups.

Conclusion: ABPM should be preferred for definitive diagnosis of HT in childhood. Patients with inadequate nocturnal fall should be evaluated carefully and followed-up regularly as it had been implicated in the development of cardiovascular disease.

Anahtar Kelimeler: Ambulatory blood pressure, Childhood, Hypertension, Nocturnal dipping

Referanslar

  1. Patel SS, Daniels SR. Ambulatory blood pressure monitoring in pediatrics. Curr Hypertens Rep 2019;21:71.
  2. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 2014;63:1116–35.
  3. Patel SS, Daniels SR. Ambulatory blood pressure monitoring in pediatrics. Curr Hypertens Rep 2019;21:71.
  4. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension Guidelines for the management of high blood pressure in children and adolescents. J Hypertens 2016;34:1887-920.
  5. Cohen JB, Lotito MJ, Trivedi UK, Denker MG, Cohen DL, Townsend RR. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis. Ann Intern Med 2019;170:853-62.
  6. Krmar RT. White-coat hypertension from a paediatric perspective. Acta Pediatr 2019; 108:44-9.
  7. Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF. NCHS growth curves for children birth–18 years. United States Vital Health Stat 1977;11:1–74.
  8. Obrycki L, Sarnecki J, Lichosik M, Sopińska M, Placzyńska M, Stańczyk M, et al. Kidney length normative values in children aged 0–19 years — a multicenter study. Pediatr Nephrol 2022;37:1075-1085.
  9. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. AAP Subcommittee on Screening and Management of High Blood Pressure in Children Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904.
  10. Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F. German Working Group on Pediatric Hypertension Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 2002;20:1995–2007.
  11. Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 2005;20:1151–5.
  12. Luo X-X, Zhu Y, Sun Y, Ge Q, Su J, So H-K, et al. Does masked hypertension cause early left ventricular impairment in youth? Front Pediatr 2018;6:167.
  13. Stabouli S, Papakatsika S, Kotronis G, Papadopoulou-Legbelou K, Rizos Z, Kotsis V. Arterial stiffness and SBP variability in children and adolescents. J Hypertens 2015;33:88–95.
  14. Düzova A, Karabay Bayazit A, Canpolat N, Niemirska A, Kaplan Bulut I, Azukaitis K, et al. Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease: findings from the cardiovascular comorbidity in children with chronic kidney disease study. J Hypertens 2019;37:2247– 55.
  15. Dost A, Bechtold-Dalla Pozza S, Bollow E, Kovacic R, Vogel P, Feldhahn L, et al. Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: impact on diabetic complications. Pediatr Diabetes 2017;18:874–82.
  16. Bakhoum CY, Vuong KT, Carter CE, Gabbai FB, Ix JH, Garimella PS. Proteinuria and Nocturnal Blood Pressure Dipping in Hypertensive Children and Adolescents. Pediatr Res 2021;90:876-81.
  17. Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The association of pediatric obesity with nocturnal nondipping on 24-hour ambulatory blood pressure monitoring. Am J Hypertens 2016;29:647–52.
  18. Seeman T, Hradsky O, Gilik J. Isolated nocturnal hypertension is associated with increased left ventricular mass index in children. Pediatr Nephrol 2021;36:1543-50.
  19. Seeman T, Hradský O, Gilík J. Nocturnal blood pressure non-dipping is not associated with increased left ventricular mass index in hypertensive children without end-stage renal failure. Eur J Pediatr 2016;175:1091–7.
  20. Szyszka M, Skrzypczyk P, Ofiara A , Maria Wabik A , Pietrzak R, Werner B, et al Circadian Blood Pressure Profile in Pediatric Patients with Primary Hypertension. J Clin Med 2022;11:5325.
  21. Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension 2019;73:35–66.
  22. Cuspidi C, Sala C, Tadic M, Gherbesi E, De Giorgi A, Grassi G, et al. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: an updated review. J Clin Hypertens (Greenwich) 2017;19:713–21.
  23. Andrade H, Pires A, Noronha N, Amaral ME, Lopes L, Martins P, et al. Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension. Rev Port Cardiol 2018;37: 783–9.
  24. Lopez-Sublet M, Girerd N, Bozec E, Machu JL, Ferreira JP, Zannad F, et al. Nondipping Pattern and Cardiovascular and Renal Damage in a Population-Based Study (The STANISLAS Cohort Study). Am J Hypertens 2019; 32:620-8.
  25. Steinthorsdottir SD, Eliasdottir SB, Indridason OS, Agustsdottir IM, Palsson R, Edvardsson VO. Prevalence of hypertension in 9- to 10-year-old Icelandic school children. J Clin Hypertens (Greenwich) 2011; 13:774–9.
  26. Lande MB, Meagher CC, Fisher SG, Belani P, Wang H, Rashid M. Left ventricular mass index in children with white coat hypertension. J Pediatr 2008;153:50–4.
  27. Kavey RE, Kveselis DA, Atallah N, Smith FC. White coat hypertension in childhood: evidence for end-organ effect. J Pediatr 2007;150:491–7.
  28. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med 2018;378:1509–20.
  29. Goulas I, Evripidou K, Doundoulakis I, Kollios K, Nika T, Chainoglou A, et al. Prevalence of masked hypertension and its association with left ventricular hypertrophy in children and young adults with chronic kidney disease: a systematic review and meta-analysis. J Hypertens 2023; 41: 699-707.
  30. Moric BV, Jelakovic B, Vidatic I, Trutin I, Jelakovic A, Stipancic G. Ambulatory blood pressure profile in office normotensive obese children: prevalence of masked hypertension and impact of parental hypertension. J Pediatr Endocrinol Metab 2020;33: 1313-20.

Telif hakkı ve lisans

Nasıl atıf yapılır

1.
Aytac MB, Doğan K, Ergül ŞA, Malkoç ND, Doğan K. Ambulatory Blood Pressure Monitoring in Children: Single Center Experience. Turk J Pediatr Dis [Internet]. 2025 Jan. 21 [cited 2025 May 25];19(1):43-8. Available from: https://turkjpediatrdis.org/article/view/1082