Kids Can Transition from White Coat HTN to True HTN

Adolescents diagnosed with white coat hypertension were not necessarily in the clear, as many eventually progressed to sustained hypertension, a researcher reported.

Out of 101 pediatric patients with white coat hypertension on ambulatory blood pressure (BP) monitoring, 51 continued to have normal BP, 32 progressed to prehypertension, and 18 had hypertension on follow-up ambulatory monitoring (a median 1.2 years later), according to Yosuke Miyashita, MD, MPH, of UPMC Children’s Hospital of Pittsburgh.

Thus, approximately half of these patients progressed to abnormal BP findings in the longitudinal study presented by Miyashita during an oral abstract session at the virtual Hypertension conference hosted by the American Heart Association.

“Initial clinic BP measurements were not associated with follow-up ABPM [ambulatory BP monitoring] phenotype,” Miyashita and colleagues concluded.

“I think we have known for some time that white coat hypertension should not be considered benign. What is interesting and surprising here is how quickly young patients with white coat hypertension may convert to hypertension. The clinical message is that children and adolescents with white coat hypertension should be followed and will need repeated ABPM,” commented Stephen Daniels, MD, PhD, of Children’s Hospital Colorado in Aurora.

A predictor of abnormal follow-up ABPM was found to be a day systolic BP index 0.9 or higher (OR 2.99, 95% CI 1.01-8.86). Day diastolic load of 10% or greater may also be important, though its association did not reach statistical significance (OR 2.65, 95% CI 0.91-7.67).

The study “provides key evidence that white coat hypertension may increase the risk of true hypertension in children, similar to what has been described in adults,” said co-author Andrew South, MD, of Brenner Children’s Hospital and Wake Forest School of Medicine in Winston-Salem, North Carolina.

“This result supports the broader use of ABPM in children with hypertension disorders,” South told MedPage Today.

The retrospective study included children enrolled from 11 centers. Roughly one in five were girls. Average age was 13.9 years.

Previously, Miyashita’s group had reported that a child’s ambulatory BP monitoring phenotype can vary over time, based on a retrospective study from two centers.

The present study had the limitations of a small sample and retrospective design. In addition, it is unclear if the findings relate to the question of the reproducibility of ambulatory BP monitoring or if there has been a real change in the natural history of patients with white coat hypertension.

Another limitation was the variable clinical practice among participating centers, South observed.

Miyashita said his group is planning for further analysis of additional clinical covariates.

Disclosures

Miyashita disclosed no relevant relationships with industry.

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