Office blood pressure measurement alone often misclassifies treatment status in children with primary hypertension

Samuel, Joyce P.; Bell, Cynthia; Hebert, Sean A.; Varughese, A.; Samuels, Joshua; Tyson, Jon E.

doi:10.1097/mbp.0000000000000299

Cited by 15 publications

(10 citation statements)

References 15 publications

(13 reference statements)

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“…Conversely, Macumber et al reported that SBP levels were similar between the obese and lean groups (22). Moreover, Samuel et al showed that there were no significant relationship between the differences OBP-ABPM values and BMI (23). Similarly, we could not show significant correlations between BMI and the differences OBP-ABPM values in our patients.…”

Section: Discussioncontrasting

confidence: 76%

Yapısal Böbrek Anomalisi olan Çocuklarda Ofis ve Ambulatuvar Kan Basıncı Arasındaki Farklılıkların Değerlendirilmesi

Cetın¹,

Tufan²

2018

Osmangazi̇ Journal of Medicine

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Structural renal abnormalities are one of the most common causes of hypertension in children. In this study, it was aimed to compare office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) values in children with structural renal abnormalities. The data from patients with structural renal abnormalities who performed ABPM were evaluated in this study. It was investigated whether there were significant differences between OBP and ABPM values. The paired t-test was used to determine the significance of the differences between OBP and ABPM values. The factors affecting the differences between office and ambulatory blood pressure values were investigated using linear regression analysis. The OBP values were significantly higher than nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p<0.01). The OBP values were positively correlated with all differences (p<0.05). Age and body mass index were positively associated with OBP-nighttime SBP difference (p = 0.001, p = 0.015, respectively). Serum blood urea nitrogen level was positively associated with OBP-nighttime DBP and OBP-24h DBP differences (β = 0.220, p = 0.033, β = 0.205, p = 0.045, respectively). There was a negative correlation between glomerul filtration rate and OBP-nighttime SBP difference (β =-0.05, p = 0.01). The performing of ABPM and the evaluation of the differences between office and ambulatory blood pressure is very important in the early recognition of the hypertension in children with structural renal anomaly.

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Section: Discussioncontrasting

confidence: 76%

Yapısal Böbrek Anomalisi olan Çocuklarda Ofis ve Ambulatuvar Kan Basıncı Arasındaki Farklılıkların Değerlendirilmesi

Cetın¹,

Tufan²

2018

Osmangazi̇ Journal of Medicine

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“…BP was assessed by ABPM, and we previously demonstrated that the ABPM diagnostic classification differed from the office BP classification in nearly 40% of visits. 30 Repeated ABPM was well tolerated by children with hypertension; .85% of monitorings were returned with a sufficient number of readings. Use of ABPM contributes to the frequent difference between pretrial and posttrial medication because pretrial therapy was often based on office BP readings, as is clinical practice.…”

Section: Figurementioning

confidence: 95%

Treating Hypertension in Children With n-of-1 Trials

Samuel¹,

Tyson²,

Green³

et al. 2019

Pediatrics

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OBJECTIVES: Clinicians prescribe antihypertensive medication to children with primary hypertension, but without data to define a particular choice as first-line therapy. A one-sizefits-all approach may not be appropriate for these patients. Our aim was to develop a personalized approach to hypertension treatment, using repeated ambulatory blood pressure monitoring (ABPM) in n-of-1 trials (single-patient randomized crossover trials).METHODS: Children undergoing hypertension management at a single pediatric referral center were offered participation in an n-of-1 trial with repeated ABPM to compare 3 commonly used medications. The medication producing the greatest blood pressure reduction, and without unacceptable side effects, was selected as the preferred therapy for the individual.RESULTS: Forty-two children agreed to participate; 7 were normotensive without medication; and 3 failed to complete one treatment cycle. Of the remaining 32 patients, lisinopril was preferred for 16, amlodipine for 8, hydrochlorothiazide for 4, and 4 had uncontrolled blood pressure on maximum doses of monotherapy. In conservative Bayesian analyses, the proportion of patients who preferred lisinopril was 49% (95% credible interval [CrI]: 32% to 69%), 24% (95% CrI: 12% to 41%) preferred amlodipine, and 12% (95% CrI: 4% to 26%) preferred hydrochlorothiazide. The preferred therapy for the majority (67%) of African American participants was lisinopril. Unacceptable side effects were reported in 24% of assessments for hydrochlorothiazide, 16% for lisinopril, and 13% for amlodipine.CONCLUSIONS: No single medication was preferred for more than half of hypertensive children. n of-1 trials with repeated ABPM may promote better informed and individualized decisions in pediatric hypertension management.

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“…not only BP <958 when measured by a physician, but also 958 when checked at home with a more than 25% difference between the two measurements). 18 White-coat hypertension is common in children with obstructive sleep apnoea syndrome, while masked hypertension can be found in renal transplant recipients. 19,20 AAP guidelines suggest using a 24-h ambulatory blood pressure monitor (ABPM) as the only reliable way to overcome these issues or when BP is borderline.…”

Section: Definition Of High Blood Pressure In Childhoodmentioning

confidence: 99%

Primary and secondary paediatric hypertension

Bassareo

Calcaterra

Sabatino

et al. 2023

Journal of Cardiovascular Medicine

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High blood pressure (BP) or hypertension is a well known risk factor for developing heart attack, stroke, atrial fibrillation and renal failure. Although in the past hypertension was supposed to develop at middle age, it is now widely recognized that it begins early during childhood. As such, approximately 5–10% of children and adolescents are hypertensive. Unlike that previously reported, it is now widely accepted that primary hypertension is the most diffuse form of high BP encountered even in paediatric age, while secondary hypertension accounts just for a minority of the cases. There are significant differences between that outlined by the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and the last statement by the American Academy of Pediatrics (AAP) concerning the BP cut-offs to identify young hypertensive individuals. Not only that, but the AAP have also excluded obese children in the new normative data. This is undoubtedly a matter of concern. Conversely, both the AAP and ESH/ESC agree that medical therapy should be reserved just for nonresponders to measures like weight loss/salt intake reduction/increase in aerobic exercise. Secondary hypertension often occurs in aortic coarctation or chronic renal disease patients. The former can develop hypertension despite early effective repair. This is associated with significant morbidity and is arguably the most important adverse outcome in about 30% of these subjects. Also, syndromic patients, for example those with Williams syndrome, may suffer from a generalized aortopathy, which triggers increased arterial stiffness and hypertension. This review summarizes the state-of-the-art situation regarding primary and secondary paediatric hypertension.

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Office blood pressure measurement alone often misclassifies treatment status in children with primary hypertension

Cited by 15 publications

References 15 publications

Yapısal Böbrek Anomalisi olan Çocuklarda Ofis ve Ambulatuvar Kan Basıncı Arasındaki Farklılıkların Değerlendirilmesi

Yapısal Böbrek Anomalisi olan Çocuklarda Ofis ve Ambulatuvar Kan Basıncı Arasındaki Farklılıkların Değerlendirilmesi

Treating Hypertension in Children With n-of-1 Trials

Primary and secondary paediatric hypertension

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