Dissertation committee:
Εμμανουήλ Μερίκας, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Απόστολος Αχείμαστος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Σ. Στεργίου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αθανάσιος Πρωτογέρου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευστάθιος Μανιός, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Μπάμιας, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξάνδρα Σολδάτου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Hypertension in children and adolescents is an issue of increasing scientific interest, mainly due to its increasing prevalence in this age group. Elevated blood pressure in childhood is associated with elevated blood pressure in adulthood and childhood blood pressure levels appear to predict the increment on adult risk of hypertension. Importantly, hypertension in childhood and adolescence is associated with asymptomatic target organ damage and blood pressure levels in adolescence predict overt cardiovascular disease in adulthood. As the case is in adults, the intermediate phenotypes of white coat hypertension and masked hypertension are not uncommon in the age groups of children and adolescents and they have been associated with asymptomatic organ damage.
Aim: To compare blood pressure measurement techniques and hypertension phenotypes in terms of their association with early target organ damage indices in children, adolescents and young adults.
Method: The study included a retrospective (individuals from previous prospective studies) and a prospective arm. Children, adolescents, and young adults 5-25 years of age who were either referred for blood pressure evaluation or they were healthy volunteers underwent: (a) office blood pressure measurements (2-3 visits, triplicate measurements with a mercury sphygmomanometer), (b) home blood pressure measurements (duplicate measurements in the morning and evening for 7 days with a validated oscillometric device), (c) 24-hour ambulatory blood pressure measurement (automated measurements at 20 minute intervals during a 24hour period, using a validated oscillometric device).Asymptomatic organ damage of at least one organ was also assessed. Target organ damage indices that were used were: (a) ultrasonographic estimation of the left ventricular mass index, (b) ultrasonographic estimation of the common carotid artery intima media thickness, (c) piezoelectric or oscillometric pulse wave velocity measurement.
Results: Two hundred fifty-one individuals were included in the analysis (mean age 14 ± 3.9 years, 70.9% men / boys, 31.1% children, 54.6% adolescents, 14.3% young adults). One hundred eighty-nine individuals had left ventricular mass index estimation, 123 intima media thickness estimation and 198 pulse wave velocity measurement. Hypertension was diagnosed in 29.5% of participants using office blood pressure measurements, in 27.1% using 24-hour ambulatory blood pressure measurement and in 26.3% using home blood pressure measurements. The agreement in the diagnosis of hypertension between office blood pressure measurement and 24-hour ambulatory blood pressure measurement was 74.5% (kappa 0.37) while between office and home blood pressure measurement was 76.1% (kappa 0.41). There was closer agreement in the diagnosis of hypertension between out of office blood pressure measurements (84.9%, kappa0.61). Left ventricular mass index had similar correlations with office systolic, 24-hour ambulatory systolic and home systolic blood pressure (r = 0.31 / 0.31 / 0.30, respectively, P <0.01).A similar correlation of office systolic, 24-hour ambulatory systolic and home systolic blood pressure with intima media thickness (r = 0.33 / 0.32 / 0.37, respectively, P <0.01) and piezoelectric pulse wave velocity was shown (r = 0.55 / 0.53 / 0.52, respectively, P <0.01), while oscillatometric while pulse wave velocity had a stronger correlation with office blood pressure compared to 24-hour and home blood pressure. In multivariate stepwise regression analysis, variation of left ventricular mass index was determined by nighttime ambulatory blood pressure, of intima media thickness by home blood pressure, and of pulse wave velocity by office and 24-hour blood pressure. Hypertension phenotypes were identified by home and 24-hour ambulatory blood pressure measurement in similar proportions. Specifically, 60.2 / 59% of participants had normal blood pressure, 13.5/ 13.9% had white coat hypertension, 10.4 / 11.6% had masked hypertension and 15.9 / 15, 5% had sustained hypertension when diagnosed by home or 24-hour ambulatory blood pressure measurement, respectively.
Conclusion: These data suggest that in young people all blood pressure measurement techniques have a strong correlation among them. Out of office blood pressure measurements are well correlated with asymptomatic target organ damage and in fact target organ damage in young patients is mainly determined by out of office measurements. Home blood pressure and 24-hour ambulatory blood pressure measurements give comparable results in terms of their association with asymptomatic organ damage and the diagnosis of hypertension phenotypes. In children and adolescents, diagnostic agreement of hypertension is greater between home and 24-hour ambulatory blood pressure measurements than between office and home or 24-hour ambulatory blood pressure measurements.
Keywords:
Hypertension, Children, Adolescents, Diagnostic methods, Target organ damage
