Masked hypertension in children and its relationship with target organ damage

Yıl 2015, , 102 - 109, 09.07.2015

Seçil Conkar Sevgi Mir Betül Sözeri Ümmügülsüm Yıldız İpek Bulut Sibel Bozovalı Ebru Yılmaz

https://doi.org/10.5799/ahinjs.01.2015.02.0498

Öz

Objective: Ambulatory blood pressure monitoring (ABPM) is important for the early diagnosis of masked hypertension. In present study, we aimed to determine the frequency of target organ damage in masked hypertension and establish a follow-up strategy in the early-stage for children.

Methods: The study population consisted of children and adolescents who were referred to our clinic for evaluation of suspected hypertension. A total of 120 children and adolescents aged 6 -17 years were investigated. Office blood pressure measurements were performed in all patients. Patients’ hypertension was evaluated with regard to target organ damage. Measurements were performed using Vicorder device. Patients underwent 24 h ambulatory blood pressure monitoring.

Results: ABPM revealed that 82 of 120 patients had hypertension. Hypertension was detected in 59 of 120 patients, by conventional blood pressure measurements. The frequency of masked hypertension was 42.7% (n=44), white coat hypertension 20.3% (n=21), and high ambulatory blood pressure was 36.8% (n=38). Increased carotid intima-media thickness was most frequently observed during the evaluation of early vascular changes in patients. We identified hypertensive retinopathy in 29 patients (24%), microalbuminuria in 21 (20.4%), and increased left ventricular mass index in 13 patients (10.8%). The frequency of hypertensive retinopathy was high, and increased carotid intima-media thickness and augmentation index were more common in masked hypertension.

Conclusion: In this study, higher frequency of masked hypertension was found in children than reported in the literature. J Clin Exp Invest 2015; 6 (2): 102-109

Key words: Children, masked hypertension, ambulatory blood pressure monitoring, end organ damage

Anahtar Kelimeler

Children, masked hypertension, ambulatory blood pressure monitoring, end organ damage

Çocuklarda maskeli hipertansiyon ve hedef organ hasarı ile ilişkisi

Öz

Amaç: Maskeli hipertansiyonun erken tanısı için ambulatuvar kan basıncı monitorizasyonu (ABPM) yapılması önemlidir. Bu çalışmamızın amacı maskeli hipertansiyon da hedef organ hasarı sıklığını belirlemek ve erken evrede çocukluk çağında izlem stratejilerini ortaya koymaktır. Yöntemler: Çalışmaya 6-17 yaş arasında olup kliniğimize hipertansiyon şüphesi ile gönderilen 120 çocuk hasta alındı. Tüm hastaların ofis kan basıncı ölçümleri gerçekleştirildi. Hipertansiyonu olan hastaların hedef organ hasarı taramaları yapıldı. Hastaların kan basıncı ölçümleri Vicorder ile yapıldı ve ABPM uygulandı. Bulgular: ABPM sonuçlarına göre 120 hastadan 82’si hipertansif bulunurken, klinikte 120 hastanın 59’u hipertansif idi. Maskeli hipertansiyon sıklığı % 42,7 (n=44), beyaz önlük hipertansiyon sıklığı %20,3 (n=21), ABPM’de hipertansiyon sıklığı %36,8 (n=38) olarak bulundu. Karotid intima media kalınlık artışı en sıklıkla görülen erken vasküler değişiklikti. Hipertansif retinopati 29 (%24) hastada, mikroalbuminüri 21(%20,4), artmış sol ventriküler kitle indeksi 13 (%10,8) hastada tespit edildi. Maskeli hipertansiyonu olan hastalarda hipertansif retinopati sıklığı daha yüksek olup, daha sıklıkla karotid intima media kalınlığı ve augmentasyon indekslerinde artışa rastlandı.Sonuç: Sonuç olarak, çalışmamızda çocuklarda maskeli hipertansiyon sıklığı literatürde bildirilenden daha yüksek bulundu

Anahtar Kelimeler

Çocuk, maskeli hipertansiyon, ambulatuvar kan basıncı ölçümü, hedef organ hasarı

Kaynakça

• National High Blood Pressure Education Program
• Working Group on High Blood Pressure in Children
• and Adolescents. Adolescents. The fourth report on
• the diagnosis, evaluation, and treatment of high blood
• pressure in children and adolescents. Pediatrics
• ;114:555-576.
• McNiece KL. and Portman R. Hypertension. In: Kher
• KK, Schnaper W, Makker SP. J. Clinical pediatric nephrology, Second edition. Informa UK Ltd. 2007:459-490.
• Stabouli S, Kotsis V, Zakopoulos N. Ambulatory blood
• pressure monitoring and target organ damage in pediatrics. J Hypertens 2007;10:1979-1986.
• Kotsis V, Stabouli S, Bouldin M, et al. Impact of obesity
• on 24-hour ambulatory blood pressure and hypertension. Hypertension 2005;45:602-607.
• Urbina E, Alpert B, Flynn J, et al. American Heart Association Atherosclerosis, Hypertension, and Obesity in You Committee. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from e American Heart Association Atherosclerosis, Hypertension, and Obesity in Committee of a council on cardiovascular disease in young and council for high
• blood pressure research. Hypertension 2008;52:433-451.
• Lurbe E, Torro I, Alvarez V, et al. persistence, and clinical significance of masked hypertension in youth. Hypertension 2005;45:493-498.
• McNiece KL, Gupta-Malhotra M, Samuels J, et al. Left
• ventricular hypertrophy in hypertensive adolescents. Analysis of risk by 2004 National High Blood Pressure Education Program Working Group Staging Criteria. Hypertension 2007;50:392-395.
• Pickering TG, Miller NH, Ogedegbe G, et al; American Heart Association; American Society of Hypertension; Preventive Cardiovascular Nurses Association. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. J Cardiovasc Nurs. 2008;4:299-323.
• Flynn JT, Daniels SR, Hayman LL, et al; American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart
• Association. Hypertension. 2014;5:1116-1135.
• National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents Pediatrics 2004;114:555-576.
• Kuczmarski RJ, Ogden CL, Guo SS, et al. CDC growth
• charts for the United States: methods and development. Vital Health Stat 11 2000;246:1-190.
• Wühl E, Witte K, Soergel M, et al; German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. Journal of Hypertension, 2002;20:1995-2007.
• Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 2004;144:7-16.
• S. Riggio G, Mandraffino M. A, Sardo R, et al. Pulse wave velocity and augmentation index, but not intima-media thickness, are early indicators of vascular damage in hypercholesterolemic children Eur J Clin Invest 2010;40: 250-257.
• Reusz GS, George S, Shroff R. Reference values of aortic pulse wave velocity in a large healthy populaConkar, et al. Masked Hypertension in children
• Zakopoulos N, Papamichael C, Papaconstantinou H, et al. Isolated clinic hypertension is not an innocent phenomenon: effect on the carotid artery structure. Am J Hypertens 1999;12:245-250.
• Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy. Comparison to necropsy findings. Am J Cardiol 1986;57:450-458.
• Daniels SR, Kimball TR, Morrison JA, et al. Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 1995;76:699-701.
• de Simone G, Daniels SR, Devereux RB, et al. Alderman MH Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992;20:1251-1260.
• Keith NM, Wagener HP, Barker NW: Some different types of essential hypertension: Their course and prognosis. Am J Med Sci 1974;268: 336-345.
• Stabouli S, Kotsis V, Toumanidis S, et al. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 2005;20:1151-1155.
• Ishikawa J, Kario K, Hoshide S, et al. Determinants of
• exaggerated difference in morning and evening blood pressure measured by self-measured blood pressure monitoring in medicated hypertensive patients: Jichi Morning Hypertension Research (J-MORE) Study. Am J Hypertens 2005;18:958-965.
• Graves JW, Alaf MM. Utility of ambulatory blood pressure monitoring in children and adolescents. Pediatr Nephrol 2006;21:1640-1652.
• Matsuoka S, Awazu M. Masked hypertension in children and young adults. Pediatr Nephrol 2004;19:651-654.
• Fujita H, Matsuoka S, Awazu M. Ambulatory blood pressure in prehypertensive children and adolescents. Pediatr Nephrol 2012;27:1361-1367.
• Coy v. Genetics of essential hypertension J Am Acad
• Nurse Pract 2005;17:219-224.
• Liu JE, Roman MJ, Pini R, et al. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med. 1999;131:564-572.
• Chaudhuri A. Pediatric ambulatory blood pressure monitoring: diagnosis of hypertension. Pediatr Nephrol 2013;28:995-999.
• Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997;130:178-184.
• Eguchi K, Ishikawa J, Hoshide S, et al. Masked hypertension in diabetes mellitus: a potential risk. J Clin Hypertens (Greenwich) 2007;9:601-607.