For a study, researchers sought to see if kids with white coat hypertension on first ambulatory blood pressure monitoring (ABPM) showed the same pattern on repeat ABPM.
A retrospective longitudinal cohort study of patients referred for high blood pressure (BP) and diagnosed with white coat hypertension by ABPM at 11 Pediatric Nephrology Research Consortium facilities, with follow-up ABPM 0.5-4.6 years later. The American Heart Association standards were used to classify the ABPM phenotype. Those with hypertensive blood pressure in the clinic were labeled as having “stable white coat hypertension,” whereas those with normal blood pressure were labeled as having “intermittent white coat hypertension.” To quantify the correlation of baseline parameters with aberrant ABPM phenotypic development, we employed multivariable generalized linear mixed effect models.
The inclusion criteria were satisfied by 89 patients (median age, 13.9 years; 78% male). The median time gap between ABPM readings was 14 months. 61% of follow-up ABPM patients advanced to an aberrant ABPM phenotype (23% ambulatory hypertension, 38% ambulatory prehypertension). Individuals aged 12 to 17 years and those with persistent white coat hypertension had a higher likelihood of moving to prehypertension or ambulatory hypertension. In the multivariable models, a baseline wakes systolic blood pressure index of 0.9 was substantially related to an increased risk of developing ambulatory hypertension (OR 3.07, 95% CI 1.02-9.23).
The vast majority of individuals with white coat hypertension had an aberrant ABPM phenotype. The study backed up the American Academy of Pediatrics’ 2017 Clinical Practice Guideline recommendation for ABPM follow-up in patients with white coat hypertension.