Abstract
Little is known about the stability of ambulatory blood pressure (ABP) patterns in children and adolescents undergoing evaluation for high blood pressure (HBP). It is possible that children with initially normal ABP may progress to hypertension (HT) or pre-hypertension (PHT), or that those with initial PHT or HT may be normal on repeat. Our objective was to assess stability of ABP patterns over time in children with HBP. We analyzed changes in ABP classification in patients undergoing a minimum of 2 ABP monitoring (ABPM) studies at least 0.5 years (yrs) apart. Exclusion criteria included known secondary HT, therapy with antihypertensive medication and inadequate recordings. ABPM were interpreted according to the 2014 AHA guidelines using BP thresholds of 95 th % for sex and height for children ≤17 yrs. For those > 18 yrs awake and sleep thresholds were 140/85 and 120/70, respectively. Dipping was considered normal if > 10%, blunted if <10% and reversed if < 0%. For those with > 2 ABPM the difference between the 1 st and last were analyzed. Two hundred ABPM on 100 patients (76 males; median age 14.6 yrs at 1st ABPM) were analyzed. Median interval between ABPM was 1.5 yrs. ABP classification was stable in 53% (53/100). As shown in the table 50% (9/18) of those with normal ABPM showed progression to PHT or HT on follow up. PreHT progressed in 31% (8/26) and improved in 38% (10/26). HT improved in 43% (20/46). Dipping designation was stable in 70% (70/100); but blunted dipping normalized in 48% (10/21). In our population ABP patterns were not stable over time, supporting the need for follow up studies even with normal initial ABPM. If confirmed in larger studies, these findings support greater use of repeat ABPM.
Published Version
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