White-coat hypertension (WCH) and masked hypertension have been associated with increased cardiovascular risk in adults. In the current study, we investigated: (a) the prevalence of WCH and masked hypertension in pediatric patients and (b) the association of these conditions with target organ damage. A total of 85 children underwent office blood pressure measurements, 24-h ambulatory blood pressure monitoring, echocardiography and ultrasonography of the carotid arteries. Subjects with both office and ambulatory normotension or hypertension were characterized as confirmed normotensives or hypertensives, respectively; WCH was defined as office hypertension with ambulatory normotension and masked hypertension as office normotension and ambulatory hypertension. WCH was found in 12.9% and masked hypertension in 9.4% of the subjects. WCH was significantly more prevalent in obese subjects, while masked hypertension was only present in non-obese ones. Confirmed and masked hypertensives had significantly higher left ventricular mass index than confirmed normotensives (34.0+/-5.8 g/m(2.7), 31.9+/-2.9 g/m(2.7) and 25.3+/-5.6 g/m(2.7), respectively, P<0.05). White-coat hypertensives tended to have higher left ventricular mass index than confirmed normotensives, but the difference was not statistically significant (27.8+/-5.1 g/m(2.7) versus 25.3+/-5.6 g/m(2.7)). No significant differences were found in the intima-media thickness of the carotid arteries between confirmed normotensives, white-coat hypertensives, masked hypertensives and confirmed hypertensives. WCH and masked hypertension are common conditions in children. Confirmed and masked hypertension in pediatric patients are accompanied by increased left ventricular mass index.

Abstract-The purpose of the present study was to determine the relationship between body mass index (BMI) and parameters derived from 24-hour ambulatory blood pressure monitoring including mean 24-hour daytime and nighttime systolic and diastolic blood pressures, 24-hour daytime and nighttime pulse pressure, mean 24-hour daytime and nighttime heart rate, dipping and nondipping status. 3216 outpatient subjects who visited our hypertension center and were never treated with antihypertensive medication underwent 24-hour blood pressure monitoring. BMI was significantly correlated with clinic systolic and diastolic blood pressures. Significant correlations were also found between BMI and mean 24-hour daytime and nighttime systolic blood pressure, 24-hour daytime and nighttime pulse pressure, and mean 24-hour daytime and nighttime heart rate. In multivariate regression analysis, clinic systolic, diastolic blood pressure, mean 24-hour systolic blood pressure, 24-hour pulse pressure, and high-density lipoprotein were independently correlated with BMI. The incidence of white coat hypertension was higher in overweight and obese patients than in normal weight subjects. Confirmed ambulatory blood pressure hypertension was also found to be higher in overweight and obese individuals compared with normal weight subjects. Our data also highlight the higher incidence of nondipping status in obesity. These findings suggest that obese patients had increased ambulatory blood pressure parameters and altered circadian blood pressure rhythm with increased prevalence of nondipping status. Key Words: blood pressure monitoring, ambulatory Ⅲ body mass index Ⅲ hypertension Ⅲ obesity T he increasing prevalence of obesity in industrialized countries is an alarming epidemic. Epidemiological studies clearly demonstrate a correlation between body weight and blood pressure in obese populations. In the Framingham Study, 70% of the new cases of essential hypertension were related to excess body fat. 1 Population studies have shown that office blood pressure closely correlates with body mass index (BMI) and other anthropometric indices of obesity such as waist-to-hip ratio. 2 Experimental studies in animals have also shown that excess weight gain caused by a chronic high-fat diet almost invariably raises blood pressure. [3][4][5] Considerable evidence suggests that excess weight gain is related to human essential hypertension. Currently, 30% to 35% of adults in the United States are obese, and Ͼ30% are overweight. 6 -10 In some groups, such as black women older than age 50, the prevalence of obesity may be as high as 70% to 80%, coinciding with a rate of hypertension of Ͼ70%. 11 Initially reserved for research purposes, ambulatory blood pressure monitoring has gradually become a widely used clinical tool for diagnostic purposes and for assessment of treatment efficacy. Evidence is available that 24-hour day or nighttime average blood pressure values correlate with subclinical organ damage more closely than office values. 12 Evidence is also availa...

Abstract-The extent of target-organ damage has been positively associated with the magnitude of blood pressure (BP) variability in essential hypertension. However, the clinical implications of the rate of BP changes have never been investigated. We evaluated the association between the rate of systolic BP (SBP) variation derived from ambulatory BP monitoring (ABPM) data analysis and the extent of common carotid artery (CCA) intima-media thickness (IMT) in normotensive (nϭ280) and in uncomplicated hypertensive subjects (nϭ234 Key Words: blood pressure Ⅲ carotid arteries Ⅲ blood pressure monitoring Ⅲ baroreflex Ⅲ ultrasonography P rospective studies in treated and untreated hypertensive patients and in the general population have demonstrated that even after adjusting for established risk factors, the incidence of cardiovascular events is correlated with blood pressure (BP) on conventional as well as ambulatory measurements. 1,2 However, ambulatory BP monitoring (ABPM) significantly refines the prediction already provided by office recordings because target-organ damage is more closely associated with ambulatory than clinic BP. 1,2 Intra-arterial beat-to-beat monitoring has shown that BP is highly variable. 3 Despite difficulties in the assessment of BP variability, particularly with noninvasive techniques, 4 evidence from cross-sectional 5-9 and longitudinal studies 10 -12 has suggested an independent and positive relationship between the extent of target-organ damage (measured by left ventricular mass, early carotid atherosclerosis, subcortical brain lesions, or a comprehensive end-organ damage score) and the magnitude of BP variability in essential hypertension. Besides, BP variability was an independent predictor for cardiovascular mortality in the general population. 13 Interestingly, Mancia et al reported recently that hypertensive patients compared with normotensive subjects present steeper fast-and short-duration beat-to-beat BP changes, documented by means of intra-arterial BP monitoring. 14 Furthermore, experimental studies have suggested that the traumatic effect of intravascular pressure on the vessel wall, which results in vascular remodeling and atherosclerosis, may be more closely associated to oscillatory than to steady laminar shear stress. [15][16][17] This evidence raises the issue of whether a hypertensive patient's prognosis depends not only on average BP level but, to some extent, also on the degree and rate of BP variation.However, the clinical implications of the time rate of noninvasive ambulatory BP changes have never been investigated in essential hypertension. Quantitative B-mode ultrasound imaging offers the opportunity to assess the intimamedia thickness (IMT) of the common carotid artery (CCA), which is considered a reliable marker for the extent of early atherosclerosis 18 and an indicator of the risk of cardiovascular diseases. 19 Moreover, Zanchetti et al reported that CCA-IMT