Abstract
Masked hypertension (MH) and white-coat hypertension (WCH) are associated with organ damage. In the present study, we examined the correlation between the magnitude of white-coat effect (WCE) or reverse WCE (RWCE) and 24-h pulse pressure (PP), an indicator of target organ damage and arterial stiffness, in children and young adults. We also examined the relationship of WCE or RWCE and blood pressure (BP) variability, another predictor of clinical outcomes. One hundred and ninety-eight subjects were studied. According to the office BP and ambulatory BP, they were divided into normotension, WCH, MH, and hypertension. The magnitude of WCE or RWCE, along with male gender and 24-h systolic BP, was the determinant of 24-h PP. In subjects with 24-h PP ≥ 61 mmHg, the magnitude of WCE or RWCE, age, male ratio, height, weight, BMI, the percentage of secondary hypertension, that of MH, office systolic BP, and 24-h systolic BP were significantly greater. There was a progressive increase in 24-h PP from normotension, WCH, MH, to hypertension. BP variability in subjects with MH was numerically highest in both systolic and diastolic. Diastolic BP variability of WCH, MH, and hypertension was significantly higher than that of normotension. Finally, the magnitude of WCE or RWCE in systolic showed a significant correlation with systolic BP variability. In conclusion, the magnitude of WCE or RWCE correlates with 24-h PP and systolic BP variability, which may suggest increased arterial stiffness in WCH and MH.
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Andrikou I, Tsioufis C, Dimitriadis K et al (2011) Similar levels of low-grade inflammation and arterial stiffness in masked and white-coat hypertension: comparisons with sustained hypertension and normotension. Blood Press Monit 16:218–223
Asmar RG, Brunel PC, Pannier BM et al (1988) Arterial distensibility and ambulatory blood pressure monitoring in essential hypertension. Am J Cardiol 61:1066–1070
Barletta GM, Flynn J, Mitsnefes M et al (2014) Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study. Pediatr Nephrol 29:1059–1065
Bjelakovic B, Lukic S, Vukomanovic V et al (2013) Blood pressure variability and left ventricular mass index in children. J Clin Hypertens (Greenwich) 15:905–909
Cahan A, Ben-Dov IZ, Mekler J et al (2011) The role of blood pressure variability in misdiagnosed clinic hypertension. Hypertens Res 34:187–192
Cecelja M, Chowienczyk P (2009) Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review. Hypertension 54:1328–1336
Chen W, Srinivasan SR, Yao L et al (2012) Low birth weight is associated with higher blood pressure variability from childhood to young adulthood: the Bogalusa Heart Study. Am J Epidemiol 176(Suppl 7):S99–S105
Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252
de Simone G, Schillaci G, Chinali M et al (2007) Estimate of white-coat effect and arterial stiffness. J Hypertens 25:827–831
Imai Y, Aihara A, Ohkubo T et al (1997) Factors that affect blood pressure variability. A community-based study in Ohasama, Japan. Am J Hypertens 10:1281–1289
James PA, Oparil S, Carter BL et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311:507–520
Karter Y, Curgunlu A, Altinisik S et al (2003) Target organ damage and changes in arterial compliance in white coat hypertension. Is white coat innocent? Blood Press 12:307–313
Lande MB, Meagher CC, Fisher SG et al (2008) Left ventricular mass index in children with white coat hypertension. J Pediatr 153:50–54
Leisman D, Meyers M, Schnall J et al (2014) Blood pressure variability in children with primary vs secondary hypertension. J Clin Hypertens (Greenwich) 16:437–441
Li S, Chen W, Srinivasan SR et al (2004) Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa Heart Study. Hypertension 43:541–546
Li Z, Snieder H, Su S et al (2010) A longitudinal study of blood pressure variability in African-American and European American youth. J Hypertens 28:715–722
Litwin M, Niemirska A, Sladowska J et al (2006) Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819
Lurbe E, Torro I, Alvarez V et al (2004) The impact of birth weight on pulse pressure during adolescence. Blood Press Monit 9:187–192
Lurbe E, Invitti C, Torro I et al (2006) The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth. J Hypertens 24:1557–1564
Matsui Y, Eguchi K, Ishikawa J et al (2007) Subclinical arterial damage in untreated masked hypertensive subjects detected by home blood pressure measurement. Am J Hypertens 20:385–391
Matsuoka S, Kawamura K, Honda M et al (2002) White coat effect and white coat hypertension in pediatric patients. Pediatr Nephrol 17:950–953
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576
Parati G, Ochoa JE, Lombardi C et al (2013) Assessment and management of blood-pressure variability. Nat Rev Cardiol 10:143–155
Schillaci G, Pucci G, Pirro M et al (2011) Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension. J Hypertens 29:869–875
Sharma AP, Mohammed J, Thomas B et al (2013) Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension. Pediatr Nephrol 28:1275–1282
Silva JA, Barbosa L, Bertoquini S et al (2004) Relationship between aortic stiffness and cardiovascular risk factors in a population of normotensives, white-coat normotensives, white-coat hypertensives, sustained hypertensives and diabetic patients. Rev Port Cardiol 23:1533–1547
Simonetti GD, von Vigier RO, Wuhl E et al (2008) Ambulatory arterial stiffness index is increased in hypertensive childhood disease. Pediatr Res 64:303–307
Skurnick JH, Aladjem M, Aviv A (2010) Sex differences in pulse pressure trends with age are cross-cultural. Hypertension 55:40–47
Soergel M, Kirschstein M, Busch C et al (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184
Stabouli S, Kotsis V, Toumanidis S et al (2005) White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 20:1151–1155
Stabouli S, Papakatsika S, Kotronis G et al (2015) Arterial stiffness and SBP variability in children and adolescents. J Hypertens 33:88–95
Stergiou GS, Kollias A, Giovas PP et al (2010) Ambulatory arterial stiffness index, pulse pressure and pulse wave velocity in children and adolescents. Hypertens Res 33:1272–1277
Sung SH, Cheng HM, Wang KL et al (2013) White coat hypertension is more risky than prehypertension: important role of arterial wave reflections. Hypertension 61:1346–1353
Takeno K, Mita T, Nakayama S et al (2012) Masked hypertension, endothelial dysfunction, and arterial stiffness in type 2 diabetes mellitus: a pilot study. Am J Hypertens 25:165–170
Ueda K, Awazu M, Konishi Y et al (2013) Persistent hypertension despite successful dilation of a stenotic renal artery in a boy with neurofibromatosis type 1. Am J Med Genet A 161A:1154–1157
Verdecchia P, Schillaci G, Borgioni C et al (1998) Ambulatory pulse pressure: a potent predictor of total cardiovascular risk in hypertension. Hypertension 32:983–988
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Fujita, H., Matsuoka, S. & Awazu, M. White-Coat and Reverse White-Coat Effects Correlate with 24-h Pulse Pressure and Systolic Blood Pressure Variability in Children and Young Adults. Pediatr Cardiol 37, 345–352 (2016). https://doi.org/10.1007/s00246-015-1283-5
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DOI: https://doi.org/10.1007/s00246-015-1283-5