Journal of the American Society of Hypertension
Research ArticleWhite coat hypertension in children: not rare and not benign?
Introduction
White coat hypertension (WCH) has been defined by elevated blood pressure (BP) readings in the office, but normal BP on ambulatory blood pressure monitoring (ABPM).1, 2 Its prevalence in pediatric studies ranges from 10% to 60% depending on the methods and the threshold limits used for office and ABPM and the characteristics of the study population.3
Clinical significance of WCH in children is a matter of debate.3 Because several earlier studies did not show significant target organ damage (TOD) associated with WCH,4, 5, 6 it has been believed that WCH represents a rather benign condition in children that does not require therapeutic intervention and monitoring.7, 8 Even in adults, the clinical significance remains uncertain9 and most studies indicate that the incidence of cardiovascular events is not significantly different between WCH and true normotension.10
The availability of normative values for ABPM in children11 has improved the classification and detection of WCH. In addition, increased availability of echocardiography for the assessment of the left ventricular mass index (LVMi) and pediatric reference values for ultrasound assessment of carotid intima media thickness (CIMT)12 have allowed for a more specific evaluation of presence of HTN-related TOD. Indeed, three recent studies in children and adolescents with WCH showed impaired arterial elasticity13 and increased LVMi,14, 15 suggesting that WCH is not a benign condition.
Our study had two major goals: to analyze the prevalence of WCH in children with office hypertension (HTN) and to compare the prevalence of hypertrophy of the left ventricle and carotid intima media thickness in children with WCH and true HTN.
Section snippets
Subjects
Our study population consisted of consecutively referred children to two tertiary university centers (Warsaw and Ottawa) for evaluation of HTN based on the elevated office BP readings between January 2004 and December 2007. HTN was confirmed by an elevated BP above the 95th percentile for age and gender on three separate occasions per current guidelines.16 According to these guidelines, all patients underwent the same workup for secondary causes of HTN, which included determination of the body
Results
In the study period, a total of 183 untreated children diagnosed with essential HTN based on office BP measurements underwent ABPM. Using results of ABPM and office BP measurements, WCH was detected in 54 patients (29.5%). The demographic and BP data in patients with true HTN and WCH are shown in Table 1. Age and BMI were not significantly different between HTN and WCH patients.
Discussion
Our study has two major findings: WCH is highly prevalent (about 30%) in children with essential HTN diagnosed on the basis of office BP measurements and WCH is associated with TOD at a similar frequency and extent as in children with confirmed sustained HTN.
Acknowledgment
We thank Stephanie Barnes, administrative assistant in the Division of Pediatric Nephrology in Ottawa, for her kind assistance in the preparation of the manuscript.
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Cited by (42)
White Coat Hypertension Persistence in Children and Adolescents: The Pediatric Nephrology Research Consortium Study
2022, Journal of PediatricsCitation Excerpt :However, even though left ventricular hypertrophy prevalence is not increased in white coat hypertension, several studies have shown that left ventricular mass index in children with white coat hypertension is intermediate between that of children with normal BP and those with hypertension.2,21-24 Similarly, children with white coat hypertension have greater carotid artery intimal-media thickness compared with children with normal BP,24,25 and youth with white coat hypertension may have endothelial dysfunction similar to that observed in children with hypertension.26 The Swedish white coat hypertension longitudinal study discussed above importantly compared the prevalence of left ventricular hypertrophy, carotid-femoral artery pulse wave velocity, and carotid intimal-media thickness at the time of follow-up between those who progressed to ambulatory hypertension and those who continued to have normal ABPM.
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Conflicts of interest: None