Abstract
Objective: This study compared home (HBP), ambulatory (ABP) and clinic (CBP) blood pressure (BP) in terms of their association with preclinical organ damage in children and adolescents. Design and method: Apparently healthy children and adolescents referred for elevated BP and healthy volunteers (age range 6–18 years) were subjected to: (i) CBP (2–3 visits, triplicate measurements, mercury sphygmomanometer), HBP (6–7 days, duplicate morning and evening measurements, validated oscillometric arm-cuff device with automated memory) and ABP (24-hours, 20 min-intervals, validated oscillometric device) measurements, (ii) echocardiographic determination of left ventricular mass index (LVMI); (iii) measurement (ultrasonography) of the common carotid intima-media thickness (IMT). Results: A total of 158 young individuals (mean age 12.9 ± 2.6 years; age range: 6–18, 108 males) were analyzed (143 had measurements of LVMI and 80 IMT). Average CBP was 119.1 ± 13.5/69 ± 8.9 mmHg (systolic/diastolic), HBP 120.2 ± 11.3/68.9 ± 6.5 mmHg and 24-hour ABP 119.4 ± 10.2/66.8 ± 5.4 mmHg. Office hypertension was diagnosed in 25% of subjects, ambulatory hypertension in 23% and home hypertension in 25%. Significant agreement was observed between HBP and ABP in detecting hypertension (85% agreement, kappa = 0.58). LVMI was correlated with pulse pressure (coefficient r = 0.25/0.26/0.21 for 24-hour/daytime/nighttime ABP, 0.23 for HBP and 0.19 for CBP; all p < 0.05). IMT was correlated with pulse pressure (coefficient r = 0.30/0.28/0.30 for 24-hour/daytime/nighttime ABP, 0.39 for HBP and 0.25 for CBP; all p < 0.05). In multivariate stepwise regression analysis (with age, gender, body mass index, and CBP, HBP, 24-hour/daytime/nighttime pulse pressures as independent variables; each BP parameter introduced once at a time in each model), the variation of LVMI was best determined (R2 = 0.20) by awake ABP pulse pressure and IMT (R2 = 0.22) by home pulse pressure. Conclusions: In young individuals, HBP and ABP measurements appear to be similar in terms of their association with preclinical organ damage and superior to the conventional CBP measurements.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have