Out-of-office blood pressure and target organ damage in children and adolescents

Abstract

The available evidence suggests a moderate but significant association between ambulatory BP and preclinical organ damage, mainly based on studies in nephropathy and/or diabetes. More data are needed in essential hypertension without nephropathy or diabetes, as well as with home measurements.

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…Home BP is lower than daytime ambulatory BP in children and adolescents (65,(68)(69)(70). Some preliminary evidence exists that home BP in children correlates with target organ damage (TOD) better than office BP (71), and that it may also better reflect the effect of risk factors on BP, such as family history or obesity (66,(72)(73). Two research groups reported good performance of home BP to 16 diagnose white-coat HTN, but a low sensitivity and positive predictive value to predict masked HTN compared to ABPM (68,74).…”

Accuracy of Automated Blood Pressure Measurement in Children

“…1,6 Home BP Monitoring Surveys in the United States, Canada, and Germany showed that >70% of the pediatric nephrologists use home BP monitoring in children with hypertension or renal disease, and 64% of them consider these measurements as more important than the office measurements. 11,12 Home BP monitoring in children has been less well studied than ambulatory monitoring 1,13,14 and shown to be useful in the detection of white-coat and masked hypertension. 15 As ambulatory BP monitoring cannot be easily performed frequently, home BP monitoring is recommended for regular follow-up of treated hypertension in children, aiming to improve the assessment of BP control.…”

One Step Further Toward a Targeted Screening Program

“…A considerable percentage of children with elevated blood pressure show increased left ventricular hypertrophy. 12 The consortium of cardiovascular children cohorts observed that persistent elevated blood pressure was associated with higher increase of the carotid intima media thickness in adults compared with children without high blood pressure or with children in whom high blood pressure normalized across the observation period. 13 Indirectly, this result also points to a potential for prevention.…”