Normotensive or Hypertensive: Adolescent Female with Headache; A Case Report

Abstract

Abstract Background Ambulatory blood pressure (ABP) monitoring became a method of choice for the diagnosis and therapeutic monitoring of arterial hypertension in adult and pediatric patients. BP load is defined as the percentage of valid BP readings above the ambulatory 95th percentile for both SBP and DBP during the entire 24-hour awake and sleep periods. BP loads in excess of 25% are generally considered abnormal, with increased loads associated with LVH). Masked hypertension (MH) is defined as normal OBP(<95th percentile) but elevated ambulatory BP levels (>95th percentile). Case Presentation This case report describes a case of an obese adolescent female complaining of chronic headache, referred for evaluation of possible hypertension, after exclusion of other organic causes of her symptom. Her office blood pressure (OBP) was normal so ABP monitoring was suggested for possible masked hypertension. Results The BPLab ABP was provided for the patient from 8 AM to 8 AM in the next day. It revealed that The 24 systolic ABP was 119Hg (75th percentile), The 24 diastolic ABP was 64 (50th percentile), daytime systolic ABP was 124 (75th percentile), nighttime systolic ABP was110(75th percentile), daytime diastolic ABP was 67(50th percentile), nighttime diastolic ABP was 58 (75th percentile). BP load was 53%. Nocturnal BP dipping was normal for both systolic and diastolic BP (16% and 19%, respectively). Conclusion High blood pressure load detected by ABP monitoring could be a sign of masked hypertension especially if associated with cardiovascular risk factors like obesity.