Evaluation of white coat hypertension in children: importance of the definitions of normal ambulatory blood pressure and the severity of casual hypertension

Sorof, Jonathan M.

doi:10.1016/s0895-7061(01)02180-x

Cited by 155 publications

(90 citation statements)

References 21 publications

(17 reference statements)

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“…Such children did not undergo diagnostic ambulatory monitoring. Sorof and colleagues 21 estimated the probability of white-coat hypertension in the pediatric population as a function of BP index (BPI; the ratio of the child's casual BP to the 95th percentile for the child's age, height, and gender). As the BPI increased from 1.0 to 1.2, the probability of white-coat hypertension fell from 87% to 15% and was Ͻ5% for a BPI of 1.3.…”

Section: Discussionmentioning

confidence: 99%

“…Children with higher BP indices had a very low probability of white-coat hypertension 21 and were at sufficient risk that it would have been unethical to withhold treatment for study purposes. These children remained in the study because to exclude all severely hypertensive children could have severely biased the results, and only clinic BP measurements were used for analysis.…”

Section: Diagnosis Of White-coat Hypertensionmentioning

confidence: 99%

“…Monitor data were considered adequate when Ͼ75% of measurements were successful. We used a more conservative definition of white-coat hypertension than most authors [21][22][23][24][25] by requiring that ambulatory BP monitoring data reveal mean daytime and 24-hour systolic and diastolic BPs be Ͻ95th percentile relative to normative data 26 and that 24-hour systolic and diastolic BP loads be Ͻ25%, despite in-clinic hypertension.…”

Section: Diagnosis Of White-coat Hypertensionmentioning

confidence: 99%

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Hyperuricemia in Childhood Primary Hypertension

2003

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Abstract-Experimental animal models suggest that uric acid might have a pathogenic role in the early development of primary hypertension. We hypothesized that serum uric acid is correlated with blood pressure in children with new-onset, untreated, primary hypertension. We evaluated 125 consecutive children referred to the Baylor Pediatric Renal Program for evaluation of hypertension. None of the subjects had previously been evaluated or treated for hypertension. The children ranged in age from 6 to 18 years (mean, 13.4Ϯ3.3) and had normal renal function (creatinine clearance Ͼ80 mL · min Ϫ1 · 1.73 m Ϫ2 ). Sixty-three children had primary hypertension, 40 had secondary hypertension, and 22 had white-coat hypertension. Forty controls with normal blood pressure were recruited from the renal clinic. Uric acid levels were directly correlated with systolic (rϭ0.80, Pϭ0.0002) and diastolic (rϭ0.66, Pϭ0.0006) blood pressure in controls and in subjects with primary hypertension and were independent of renal function. Serum uric acid concentrations Ͼ5.5 mg/dL were found in 89% of subjects with primary hypertension, in 30% with secondary hypertension, in 0% with white-coat hypertension, and in 0% of controls. We conclude that serum uric acid is directly correlated with blood pressure in untreated children and that a serum uric acid value Ͼ5.5 mg/dL in an adolescent being evaluated for hypertension strongly suggests primary hypertension as opposed to white-coat or secondary hypertension. These results are consistent with the hypothesis that uric acid might have a role in the early pathogenesis of primary hypertension. Key Words: uric acid Ⅲ hypertension, essential Ⅲ children Ⅲ renal disease H ypertension, the most common form of cardiovascular disease, is present in nearly 25% of adults and increases in prevalence with age. Hypertension results in increased morbidity and mortality by dramatically escalating the risk of myocardial infarction, congestive heart failure, stroke, peripheral vascular disease, and renal failure. 1,2 Several clinical and laboratory observations are consistent with the hypothesis that uric acid might be important in the development of primary hypertension in humans. An association of gout with hypertension was first noted in 1879. 3 Twenty-five percent to 40% of adult patients with untreated hypertension have hyperuricemia (Ͼ6.5 mg/dL), and many more have a high-normal serum uric acid value (5.0 to 6.5 mg/dL). 4,5 The relation between uric acid and blood pressure (BP) is continuous and is observed in both AfricanAmericans and whites. 6 Furthermore, hyperuricemia predicts the development of, and is an independent risk factor for, hypertension. 7,8 Finally, we demonstrated that hyperuricemic rats develop hypertension 9 followed by preglomerular arteriolopathy. 10 Early hypertension is dependent on the reninangiotensin system and nitric oxide pathways 9 ; however, once preglomerular vascular disease develops, hypertension is driven by the kidney, and lowering uric acid levels is no longer protective. 1...

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Section: Discussionmentioning

confidence: 99%

Section: Diagnosis Of White-coat Hypertensionmentioning

confidence: 99%

Section: Diagnosis Of White-coat Hypertensionmentioning

confidence: 99%

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Hyperuricemia in Childhood Primary Hypertension

2003

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“…Therefore, we recommend that children watch an animation movie -carefully selected to provide only a low level of stimulation -whilst following the procedures outlined above. The inclusion of a movie may also prevent the child from falling asleep -a state known to affect vascular function 10) -and may help to limit 'white coat' hypertension, which can effect both adults 14) and children 15) . 'White coat' hypertension can also be limited through familiarization to measurement procedures during separate visits.…”

Section: Dietmentioning

confidence: 99%

Guidelines for the Use of Pulse Wave Analysis in Adults and Children

Stoner

Lambrick

Faulkner

et al. 2013

JAT

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“…147 The phenomenon of white-coat hypertension occurs in children just as in adults, 148 and therefore it makes sense to use out-of-office monitoring in addition to clinic measurements. Thus far, there are relatively few studies of HBPM in children.…”

Section: Childrenmentioning

confidence: 99%

Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring

Pickering¹,

Miller

Ogedegbe³

et al. 2008

Hypertension

485

235

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Abstract-Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of Ն12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is Ͻ135/85 mm Hg or Ͻ130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed. (Hypertension. 2008;52:10-29.)

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Evaluation of white coat hypertension in children: importance of the definitions of normal ambulatory blood pressure and the severity of casual hypertension

Cited by 155 publications

References 21 publications

Hyperuricemia in Childhood Primary Hypertension

Hyperuricemia in Childhood Primary Hypertension

Guidelines for the Use of Pulse Wave Analysis in Adults and Children

Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring

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