Yosuke Miyashita1, Coral Hanevold2, Anna Faino3, Julia Scher4, Marc Lande4, Ikuyo Yamaguchi5, Joel Hernandez6, Alisa Acosta7, Donald J Weaver8, Jason Thomas9, Mahmoud Kallash10, Michael Ferguson11, Ketan N Patel12, Andrew M South13, Megan Kelton2, Joseph T Flynn2. 1. University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: yosuke.miyashita@chp.edu. 2. Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA. 3. Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, WA. 4. University of Rochester Medical Center, Rochester, NY. 5. The University of Oklahoma Health Sciences Center, Oklahoma City, OK. 6. Kaiser Permanente, Los Angeles, CA. 7. Texas Children's Hospital, Baylor College of Medicine, Houston, TX. 8. Levine Children's Hospital, Charlotte, NC. 9. Helen DeVos Children's Hospital, Grand Rapids, MI. 10. Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH. 11. Boston Children's Hospital, Harvard Medical School, Boston, MA. 12. McGovern Medical School at UTHealth, Houston, TX. 13. Brenner Children's, Wake Forest School of Medicine, Winston-Salem, NC.
Abstract
OBJECTIVES: To determine whether youth with white coat hypertension on initial ambulatory blood pressure monitoring (ABPM) continue to demonstrate the same pattern on repeat ABPM. STUDY DESIGN: Retrospective longitudinal cohort study of patients referred for high blood pressure (BP) and diagnosed with white coat hypertension by ABPM who had follow-up ABPM 0.5-4.6 years later at 11 centers in the Pediatric Nephrology Research Consortium. We classified ABPM phenotype using the American Heart Association guidelines. At baseline, we classified those with hypertensive BP in the clinic as "stable white coat hypertension," and those with normal BP as "intermittent white coat hypertension." We used multivariable generalized linear mixed effect models to estimate the association of baseline characteristics with abnormal ABPM phenotype progression. RESULTS: Eighty-nine patients met the inclusion criteria (median age, 13.9 years; 78% male). Median interval time between ABPM measurements was 14 months. On follow-up ABPM, 61% progressed to an abnormal ABPM phenotype (23% ambulatory hypertension, 38% ambulatory prehypertension). Individuals age 12-17 years and those with stable white coat hypertension had greater proportions progressing to either prehypertension or ambulatory hypertension. In the multivariable models, baseline wake systolic BP index ≥0.9 was significantly associated with higher odds of progressing to ambulatory hypertension (OR 3.07, 95% CI 1.02-9.23). CONCLUSIONS: The majority of the patients with white coat hypertension progressed to an abnormal ABPM phenotype. This study supports the 2017 American Academy of Pediatrics Clinical Practice Guideline's recommendation for follow-up of ABPM in patients with white coat hypertension.
OBJECTIVES: To determine whether youth with white coat hypertension on initial ambulatory blood pressure monitoring (ABPM) continue to demonstrate the same pattern on repeat ABPM. STUDY DESIGN: Retrospective longitudinal cohort study of patients referred for high blood pressure (BP) and diagnosed with white coat hypertension by ABPM who had follow-up ABPM 0.5-4.6 years later at 11 centers in the Pediatric Nephrology Research Consortium. We classified ABPM phenotype using the American Heart Association guidelines. At baseline, we classified those with hypertensive BP in the clinic as "stable white coat hypertension," and those with normal BP as "intermittent white coat hypertension." We used multivariable generalized linear mixed effect models to estimate the association of baseline characteristics with abnormal ABPM phenotype progression. RESULTS: Eighty-nine patients met the inclusion criteria (median age, 13.9 years; 78% male). Median interval time between ABPM measurements was 14 months. On follow-up ABPM, 61% progressed to an abnormal ABPM phenotype (23% ambulatory hypertension, 38% ambulatory prehypertension). Individuals age 12-17 years and those with stable white coat hypertension had greater proportions progressing to either prehypertension or ambulatory hypertension. In the multivariable models, baseline wake systolic BP index ≥0.9 was significantly associated with higher odds of progressing to ambulatory hypertension (OR 3.07, 95% CI 1.02-9.23). CONCLUSIONS: The majority of the patients with white coat hypertension progressed to an abnormal ABPM phenotype. This study supports the 2017 American Academy of Pediatrics Clinical Practice Guideline's recommendation for follow-up of ABPM in patients with white coat hypertension.
Authors: Joseph T Flynn; David C Kaelber; Carissa M Baker-Smith; Douglas Blowey; Aaron E Carroll; Stephen R Daniels; Sarah D de Ferranti; Janis M Dionne; Bonita Falkner; Susan K Flinn; Samuel S Gidding; Celeste Goodwin; Michael G Leu; Makia E Powers; Corinna Rea; Joshua Samuels; Madeline Simasek; Vidhu V Thaker; Elaine M Urbina Journal: Pediatrics Date: 2017-08-21 Impact factor: 7.124
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: J Am Coll Cardiol Date: 2017-11-13 Impact factor: 24.094
Authors: Dénes Páll; Mária Juhász; Szabolcs Lengyel; Csilla Molnár; György Paragh; Béla Fülesdi; Eva Katona Journal: J Hypertens Date: 2010-10 Impact factor: 4.844