Assistant professor Cincinnati children’s hospital medical center Cincinnati, Ohio, United States
Background: Diagnosing hypertension in children and adolescents can be challenging. Ambulatory blood pressure (ABP), the gold standard for diagnosis of BP phenotype, is not always tolerated- making home BP (HBP) monitoring a potential alternative. Objective: We sought to determine if HBP correlates with ABP and with left ventricular mass (LVM) better than other blood pressure modalities. Design/Methods: 18 individuals aged 9 to 18 (mean 15.6 ± 2.4) years referred for elevated blood pressure had auscultatory office BP (OBP) obtained and completed 3 weeks of HBP, a 24-h ABP recording, and an echocardiogram as part of an on-going prospective study. Results: There was a higher percentage of participants with elevated LVM when systolic HBP was greater than the 95th percentile when compared to systolic ABP and systolic OBP. Systolic HBP had a significant correlation with 24-hour systolic ABP (r= 0.61, p=0.008), but systolic OBP did not have a significant correlation with either. Only systolic HBP and morning systolic HBP had significant correlations with LVM (r= 0.47, p=0.048 and r= 0.52, p=0.027 respectively). HBP and ABP were indexed to the 50th percentile by modality for multivariable analysis. The relationship between HBP and LVM did not remain significant after adjusting for age, sex, race and BMI.
Conclusion(s): Compared with OBP and ABP, systolic HBP was more strongly associated with LVM. The relationship was not significant on multivariable analysis likely due to the small sample size. This data suggests that HBP monitoring may be a suitable alternative for diagnosing hypertension in pediatric populations.
Table 1. Patient Characteristics (N=18) Table 1. .jpegABP, ambulatory blood pressure; BMI, body mass index; BMIz, BMI z-score; HBP, home blood pressure; LVMi, left ventricular mass index; OBP, office blood pressure; OBPz, OBP z-score; SBPi, systolic BP index.
Figure 1. Prevalence of elevated LVM and normal LVM by home or ambulatory systolic blood pressure. Figure 1. .jpegLVMi, left ventricular mass index; ABP, Ambulatory blood pressure; HBP, home blood pressure; OBP, office blood pressure.
Table 2. Correlation of Mean Systolic Office, Home, and Ambulatory Blood Pressure with Left Ventricular Mass Index (N=18) Table 2. .jpegABP, ambulatory blood pressure; ABPi, ambulatory blood pressure index; HBP, home blood pressure; HBPi, home blood pressure index; OBP, office blood pressure.
