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Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis
Abstract
OBJECTIVE: In children, out-of-office blood pressure (BP) assessment (especially ambulatory monitoring) is regarded as indispensable for accurate hypertension diagnosis. This article reviewed the evidence on the association between out-of-office BP measurements and preclinical organ damage indices in children. METHODS: A systematic review and meta-analysis of 93 relevant articles (1974-2012) was performed. RESULTS: Analysis of 10 studies (n = 480, pooled age 14.4 years, with hypertension 33%, renal disease 27%, type 1 diabetes 10%) revealed a significant association between systolic ambulatory BP and left ventricular mass index (LVMI), with pooled correlation coefficient r = 0.40 [95% confidence interval (CI) 0.30-0.50]. Eleven studies reported data on LVMI differences between normotensive (n = 428) and hypertensive children (n = 432), with higher values in the latter group by 6.53 g/m(2.7) (95% CI 4.73-8.33). A moderate association was found between systolic ambulatory BP and carotid intima-media thickness (three studies, n = 231, age 13.3 years, pooled r = 0.32, 95% CI 0.21-0.44), as well as between diastolic ambulatory BP and urine albumin excretion (five studies, n = 355, age 13.1 years, type 1 diabetes 42%, reflux nephropathy 28%, pooled r = 0.32, 95% CI 0.05-0.58). Two studies reported on the association between home BP and LVMI, with one of them showing comparable coefficients as for ambulatory monitoring. CONCLUSION: The available evidence suggests a moderate but significant association between ambulatory BP and preclinical organ damage, mainly based on studies in nephropathy and/or diabetes. More data are needed in essential hypertension without nephropathy or diabetes, as well as with home measurements.
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In the citing paper
“ABPM is currently regarded as the reference method for hypertension diagnosis in children and adolescents as white-coat, masked and nocturnal hypertension are as common as in the adults [174–178]”
In the citing paper
“HBPM appears to have several potential advantages over both OBP and ABPM, including user convenience and acceptance, and the ability to obtain multiple measurements in the usual environment over several days, weeks or months [174–179]”
In the citing paper
“there is close agreement between home and ambulatory BP monitoring in diagnosing hypertension phenotypes within the range of 80–85% [176–179]”
In the citing paper
“the association of HBPM with several indices of preclinical target-organ damage, mainly LVMI, appears to be superior to OBP measurements and similar to ABPM [176–178,180,181]”
In the citing paper
“The role of HBPM in the evaluation of pediatric hypertension remains largely unrecognized and inadequately investigated, even though the method is being used in clinical practice in children with hypertension [176,177]”
In the citing paper
“Preliminary evidence for HBPM in children shows that, as in the adults: its reproducibility is superior to that of OBP measurements and close to that of ambulatory monitoring [21,176–178]”
In the citing paper
“in children and adolescents, HBP is considerably lower than daytime ABP, which is attributed to the higher level of physical activity of the young individuals during the day [176,185]”
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Metadata
- Authors
- Kollias, A., Dafni, M., Poulidakis, E., Ntineri, A., & Stergiou, G. S.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Stergiou, George S.
- Venue
- Journal of Hypertension
- Published
- 2014-12
- Volume
- 32
- Issue
- 12
- Pages
- 2315-2331
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2077599588
- Cited by
- 125
- References
- 112
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 11 · 2022: 14 · 2021: 13 · 2020: 9 · 2019: 13 · 2018: 19 · 2017: 13 · 2016: 14 · 2015: 8
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- out-of-office blood pressure, ambulatory blood pressure monitoring, home blood pressure monitoring, target organ damage, pediatric hypertension, adolescents, left ventricular mass index, carotid intima-media thickness, albuminuria, kidney disease, type 1 diabetes, reflux nephropathy
- MeSH terms
- Adolescent, Blood Pressure, Child, Female, Humans, Hypertension, Kidney Diseases, Male, Hypertrophy, Left Ventricular, Blood Pressure Monitoring, Ambulatory
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