White Coat Hypertension Often Seen in Children - Brief Article

0 Comments | Family Practice News, June 1, 2001 | by Bruce Jancin

ORLANDO, FLA. -- White coat hypertension is common in childhood, too, Dr. Rae-Ellen W. Kavey reported at the annual meeting of the American College of Cardiology.

In white coat hypertension, a patient's blood pressure is persistently elevated in a physician's office but is in the normal range. at other times. An estimated 20%-50% of adults who have a high blood pressure in the clinic turn out to have white coat hypertension.

Identifying these patients is considered worth while because they don't run the same risk of serious disease complications as do true hypertensives, and therefore they don't need to be subjected to the cost and risks of antihypertensive drug therapy, said Dr. Kavey of Northwestern University, Chicago.

The prevalence of white coat hypertension among children with high in-office blood pressure hasn't previously been examined, she noted.

She reported on 159 consecutive children aged 4-18 years (mean age 12.8) who were referred to a pediatric preventive cardiology clinic for evaluation of high blood pressure; 57% of the children were obese.

With careful in-office measurement, 41 of the 159 referred patients were found to have normal blood pressure. The other 118 had an office systolic blood pressure above the 95th percentile for their age, gender, and body weight;: 25 of these subjects also had a diastolic blood pressure in excess of the 95th percentile, Dr. Kavey reported.

All 118 of these youths were then evaluated by round-the-clock ambulatory blood pressure monitoring. Most of them (57%) were classified as hypertensive based upon a mean waking systolic and/or diastolic pressure that was more than one standard deviation above normal for age and gender.

None .of these children had an elevated blood pressure during sleep without also having high blood pressure while awake, she noted.

The other 43% of these subjects were judged to have white coat hypertension based upon normal mean blood pressures while awake and asleep, Dr. Kavey said.

Echocardiographic evaluation showed that the children who were truly hypertensive upon ambulatory monitoring had increased left ventricular mass, indicating that important end-organ adverse effects of high blood pressure can begin in childhood. Left ventricular hypertrophy was not noted in the children with white coat hypertension, she said.