Abstract
BackgroundThe clinical significance of isolated systolic hypertension with normal central blood pressure known as spurious hypertension (sHT) in adolescents and its evolution over time is not known.MethodsThe aim of this study was to analyze changes in office, ambulatory blood pressure (ABPM), central systolic blood pressure (cSBP), hemodynamic parameters, and target organ damage (TOD) over a 1-year follow-up in a group of non-obese children with sHT.ResultsOf 294 patients referred for primary hypertension, 138 patients (31 girls; 22%) had hypertension confirmed by ABPM. 48/138 (35%) patients (7 girls; 15%) were diagnosed with sHT (elevated office and ambulatory systolic BP, but normal cSBP); 43 of them (6 girls; 14%) were followed for 12 ± 3 months during non-pharmacological therapy. At baseline 7 (16%) patients had borderline values of cIMT or LVMi indicating mild TOD. After 12 months, 10/43 (3 girls; 23%) patients developed sustained HT (elevated office, ambulatory BP and cSBP), 11/43 (1 girl; 26%) maintained sHT, and 22/43 (2 girls; 51%) evolved to white coat hypertension or normotension. The cSBP values increased in 27 patients (4 girls; 63%), but the group average remained in the normal range. Prevalence of TOD did not change during observation. The multivariate regression analysis showed that the only predictor of cSBP change over time was a change in serum uric acid level.ConclusionsIn conclusion, after 1 year of non-pharmacological treatment, 23% of adolescents with sHT developed sustained hypertension, with the main predictor of cSBP change being the change in serum uric acid.
Highlights
Spurious hypertension is a phenotype of primary hypertension (PH) defined as elevated office and ambulatory systolic blood pressure (SBP), yet maintaining normal central systolic blood pressure and presents clinically as isolatedElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Because ISH is the dominant hemodynamic phenotype in children with PH and males dominate among hypertensive children, it is important to assess the risk associated with ISH and normal cSBP in youth with PH.To date, only a few studies have assessed the prevalence of spurious hypertension (sHT) among adults with ISH and its clinical relevance
There were no significant changes during the observation period in biochemical and target organ damage (TOD) parameters and the 24-h SBP, DBP, and mean arterial pressure (MAP) decreased over time (Table 1, Table 1S)
The change of uric acid concentration was associated with the highest/large effect size (Cohen d = 1.05) on the change of cSBP, the change in following variables had a medium to large effect size (Cohen d = 0.5 to 0.8) on the change of cSBP: heart rate, cardiac output, pulse wave velocity (PWV) standard deviation score (SDS), PWV, central pulse pressure (cPP), AugPress, cardiac index, weight, left ventricular mass index (LVMi), body mass index (BMI), stroke volume, and cholesterol (Fig. 3)
Summary
Spurious hypertension (sHT) is a phenotype of primary hypertension (PH) defined as elevated office and ambulatory systolic blood pressure (SBP), yet maintaining normal central systolic blood pressure (cSBP) and presents clinically as isolated. Because ISH is the dominant hemodynamic phenotype in children with PH and males dominate among hypertensive children, it is important to assess the risk associated with ISH and normal cSBP in youth with PH. Studies by Saladini et al and Palatini et al showed that sHT in young adult males is a mild condition and patients with sHT are at a Pediatr Nephrol (2021) 36:361–371 low risk of developing sustained hypertension (15.2%), similar to the normotensive population (14.7%). The clinical significance of isolated systolic hypertension with normal central blood pressure known as spurious hypertension (sHT) in adolescents and its evolution over time is not known
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