PP.06.16] HOME VERSUS AMBULATORY BLOOD PRESSURE AND TARGET-ORGAN DAMAGE IN CHILDREN AND ADOLESCENTS

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.