SAN FRANCISCO, CA — A new study shows that ambulatory blood-pressure (BP) patterns are not stable over time in children, supporting the need for follow-up studies even in children with initially normal ambulatory BP monitoring (ABPM), the researchers say[1].

The study was presented at the 2017 American Heart Association (AHA) Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, American Society of Hypertension Joint Scientific Sessions.

Until now, little was known about the stability of ambulatory BP patterns in children and adolescents undergoing evaluation for high blood pressure, noted Dr Coral Hanevold (University of Washington School of Medicine, Seattle) and colleagues. It's possible that children with initially normal ambulatory BP may progress to hypertension or prehypertension or that those with initial prehypertension or hypertension may be normal on repeat testing.

They assessed the stability of ambulatory BP patterns over time in 100 children (76 male) with high blood pressure.

"We wanted to be able to advise parents whether white-coat hypertension might progress to hypertension and whether prehypertension [on ABPM] might improve, or worsen," Hanevold told | Medscape Cardiology.

Participants in the study had a median age of 14.6 years at first ABPM. All of them underwent at least two ABPM studies at least 6 months apart. Exclusion criteria included known secondary hypertension, use of antihypertensive medication, and inadequate recordings. Altogether, the researchers had 200 ABPM studies. The median interval between studies was 1.5 years.

ABPM was interpreted according to the 2014 AHA guidelines using BP thresholds of 95th percentile for sex and height for children aged 17 and younger. For those over age 18, awake and sleep thresholds were 140/85 and 120/70 mm Hg, respectively. Dipping was considered normal if >10%, blunted if <10%, and reversed if <0%. For those with more than two ABPM studies, the difference between the first and last was analyzed.

The researchers found that ambulatory BP classification was stable in 53% of children (53/100). Half of the children (nine of 18) with normal ABPM showed progression to prehypertension or hypertension on repeat ABPM.

Prehypertension progressed in 31% (eight of 26) and improved in 38% (10/26). Hypertension improved in 43% of children (20/46). Dipping designation was stable in 70% of participants (70/100), but blunted dipping normalized in 48% (10/21).

"If confirmed in larger studies, these findings support greater use of repeat ABPM" in children, the researchers conclude.

The main message for clinicians, Hanevold said in an interview, is that "follow-up ABPM should be considered even in those with normal ABPM, [as] the pattern often differs on follow-up."

Commenting on the findings was pediatric cardiologist Dr Joseph Mahgerefteh (Children's Hospital at Montefiore, Bronx, NY).

"From this preliminary data, it's not possible to say what's the cause of these blood-pressure changes seen over one and a half years, such as change in BMI or lifestyle changes," Mahgerefteh said. "I think the study is justifying repeating ambulatory blood-pressure monitoring to see if there is improvement or worsening."

Still, he added, "there is some limitation to ambulatory blood-pressure monitoring in children. In my own experience, I would say in about 30% of the monitors, there are not sufficient data to be able to diagnose a blood-pressure problem with certainty.

"These are very interesting results," said Mahgerefteh, "and I am looking forward to the published paper to see the full results."

The study had no funding and the authors have disclosed no relevant financial relationships.  

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