Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring

Stergiou, George S.; Nasothimiou, Efthimia; Giovas, Periklis; Kapoyiannis, Anastasios; Vazeou, A.

doi:10.1097/hjh.0b013e328301c411

Cited by 103 publications

(78 citation statements)

References 28 publications

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“…23,24 In the present analysis, 754 subjects (338 boys) with mean age 12.2 ± 3.2 years and height 156.6 ± 17.4 cm were included. The distribution of the obesity indices is presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…23,24 The Arsakeion school is located near the centre of Athens and is attended by children mainly from middle-class families living all over the city. The study was designed to include 30 boys and 30 girls from each year of age from 6 to 18 years.…”

Section: Design and Populationmentioning

confidence: 99%

“…24 The primary objective of the study was to define the normal range of HBP in children and adolescents and these data have been published. 23,24 Participants were invited to participate on a voluntary basis and their parents signed an informed consent form before entry to the study. The study protocol was approved by the Ethics Committee of the School of Medicine, University of Athens, the Scientific Committee of the Sotiria Hospital, Athens and the Filekpaideftiki Etaireia, ArsakeiaTositsia Schools.…”

Section: Design and Populationmentioning

confidence: 99%

“…22 Recently, it has been shown that home blood pressure (HBP) monitoring is an applicable and more reliable method for the evaluation of BP in children. 23 However, data on the association between HBP and obesity have not been reported yet.…”

Section: Introductionmentioning

confidence: 99%

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Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

et al. 2009

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Obesity is related to office blood pressure (OBP). Important discrepancies exist between OBP and home blood pressure (HBP), providing complementary information for the management of hypertension. The association between obesity and HBP has not been investigated in children. The evidence on the role of obesity in the predominance of systolic blood pressure (SBP) over diastolic (DBP) in paediatric hypertension is limited. A total of 778 healthy subjects aged 6-18 years were recruited in this study. OBP and HBP were measured using electronic devices validated in children. Anthropometric measurements were measured and expressed as z-scores for height or age. Among all indices of obesity (z-scores), body mass index (BMI) showed the best association with BP. The effect of obesity (BMI) was more pronounced on: (i) SBP than DBP and (ii) H-SBP than O-SBP (O-SBP: r 2 ¼ 0.09, O-DBP: r 2 ¼ 0.05, H-SBP: r 2 ¼ 0.12, H-DBP: r 2 ¼ 0.06). The prevalence of systolic hypertension was higher than that of diastolic hypertension. This difference was significant only in office readings and independent from obesity (normal weight: 6.3% systolic hypertension versus 1.2% diastolic; obese: 37.9% versus 6.9%, Po0.05 for both). These data imply that in children and adolescents the z-score of BMI is the most appropriate index of the association between BP and obesity. It also suggests that obesity is probably more closely associated with home than office BP. Finally, although obesity appears to affect SBP more than DBP, these results suggest that the predominance of systolic hypertension in children and adolescents might not be only related to obesity but also to the measurement setting (office).

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Section: Resultsmentioning

confidence: 99%

Section: Design and Populationmentioning

confidence: 99%

Section: Design and Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

et al. 2009

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“…However, all the methods of BP measurements were highly correlated to each other and, in line with previous data, there was agreement between ambulatory and home BP in diagnosing hypertension in 85% of the study participants. 29 All BP measurements were correlated with target-organ damage, that is, PWV and LVM; in this respect, however, ambulatory and home BP showed a consistent superiority compared with CBP. Moreover, in multivariate analyses only ambulatory and home BP appeared to be independent predictors of target-organ damage.…”

Section: Discussionmentioning

confidence: 81%

Relationship of home blood pressure with target-organ damage in children and adolescents

et al. 2011

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The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13±3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1 ± 15.1/71 ± 12.9 mm Hg (systolic/diastolic), HBP 121.3 ± 11.5/69.4 ± 6.6 mm Hg and 24-h ABP 118.9 ± 12/ 66.6 ± 6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r¼0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all Po0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r¼0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all Po0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r¼0.30 and 0.28, respectively, Po0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R 2 ¼0.22, beta ± s.e. ¼0.06 ± 0.01), whereas LVM was determined (R 2 ¼0.67) by 24-h pulse pressure (beta¼1.21±0.41), age (beta¼2.93±1.32), 24-h heart rate (beta¼À1.27±0.41) and BMI (beta¼1.78±0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.

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Screening for Hypertension in Children and Adolescents

Gartlehner

Schaaf

Orr

et al. 2020

JAMA

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ImportanceChildhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks.ObjectiveTo update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force.Data SourcesPubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020.Study SelectionFair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions.Data Extraction and SynthesisTwo reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively.Main Outcomes and MeasuresSensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments.ResultsForty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were −4.38 mm Hg (95% CI, −7.27 to −2.16) for angiotensin-converting enzyme inhibitors and −3.07 mm Hg (95% CI, −4.99 to −1.44) for angiotensin receptor blockers. Candesartan reduced SBP by −6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (−4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (−2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (−7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure.Conclusions and RelevanceObservational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.

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Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring

Cited by 103 publications

References 28 publications

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

Relationship of home blood pressure with target-organ damage in children and adolescents

Screening for Hypertension in Children and Adolescents

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