Dissertation committee:
Γεώργιος Στεργίου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Λουκιανός Ραλλίδης, , Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κυριακή Καραβανάκη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Μακρυλάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευστάθιος Μανιός, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξάνδρα Σολδάτου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Βάια Λαμπαδιάρη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Night-time blood pressure (BP) appears to be the most important aspect of the BP profile in terms of prognosis and is regarded as a unique advantage of ambulatory BP (ABP) monitoring. In the last years novel low-cost home BP (HBP) monitors, which can obtain automated measurements during night-time sleep, appear to provide similar BP values, reasonable agreement in detecting night-time hypertension and similar associations with preclinical organ damage as ABP. However, the evidence on association of night-time HBP with preclinical organ damage in children is limited, with data available only using 24-hour ABP monitoring.
Objective: The objective of this study was to investigate the clinical relevance of night-time BP assessed using novel HBP monitoring technology in children and adolescents, in terms of feasibility, acceptability by users and its association with classic 24-hour ABP monitoring regarding BP values and relationship with preclinical target organ damage.
Methods: Children and adolescents (aged 6-18 years) referred for elevated BP were evaluated with: i) office BP measurements (2-3 visits, triplicate measurements, mercury sphygmomanometer), ii) 24h ABP monitoring (Microlife WatchBP O3) and iii) HBP monitoring during daytime (7 days, duplicate morning and evening measurements) and night-time (automated asleep measurements for 3 nights with 3 hourly measurements/night) (Microlife WatchBP Home N). Preclinical organ damage was assessed by (a) echocardiographic left ventricular mass index (LVMI), (b) carotid intima-media thickness (cIMT), (c) carotid distensibility coefficient (cDC), and (d) carotid-femoral pulse wave velocity (cfPWV). In the end of the study, participants filled in a questionnaire regarding their preference between HBP and ABP monitoring.
Results: Ninety-one individuals were analyzed (mean age 13.3±2.8 years, 54 males, 17 with elevated ABP). There was a close association between daytime (awake) ABP and HBP (r=0.81/0.77, systolic/diastolic), and between night-time (asleep) values (r=0.78/0.60) (all p<0.05). Daytime HBP was slightly lower than daytime ABP (difference -2.0±6.5/-0.9±5.1 mmHg, systolic/diastolic, p<0.01/NS), whereas night-time HBP was slightly higher than night-time ABP (2.6±7.2/2.2±6.1 mmHg, p<0.01 for both). Night-time systolic ABP and HBP were correlated with LVMI (r=0.37 and 0.29 respectively), cIMT (0.45, 0.47), cDC (-0.22, -0.20), cfPWV (0.47, 0.53) (p=NS for comparisons between methods). The agreement between night-time HBP and ABP in identifying individuals with night-time hypertension (≥95th percentile for night-time ABP) was 82% (kappa 0.49, p<0.01), and non-dippers 57% (kappa 0.19, p=0.03). Finally, 75% of the participants reported that they would prefer HBP for their next assessment, whereas 25% would prefer ABP monitoring.
Conclusions: The findings of this study suggest that in children and adolescents night-time BP assessed using a novel, low-cost home monitor is (a) feasible and (b) well accepted by children and (c) provides similar BP values and (d) associations with preclinical organ damage as night-time ABP. Moreover, (e) there is reasonable agreement between home and ambulatory BP monitoring in detecting night-time hypertension and (f) non-dippers.
Keywords:
Adolescents, Blood pressure, Hypertension, Pediatric, Self blood pressure monitoring, leep
