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Ambulatory blood pressure monitoring parameters in obese children and adolescents with masked hypertension

Yegül-Gülnar, Gökçea,,*; Kasap-Demir, Beldeb,,c,,*; Alparslan, Canerb; Çatli, Gönüld,,e; Mutlubaş, Fatmab; Yavaşcan, Önderb; Özkan, Bülentf; Dündar, Bumin Nurid,,e; Aksu, Nejatb,,*

doi: 10.1097/MBP.0000000000000402
Clinical Methods and Pathophysiology

Objective We aimed to compare the demographic, laboratory, and ambulatory blood pressure monitoring (ABPM) parameters of patients with masked hypertension (MHT), define factors predicting MHT, and determine the ABPM parameters affecting left ventricular mass index (LVMI) in obese youth.

Methods Data of obese patients were evaluated retrospectively. Patients with ambulatory hypertension (AHT), white-coat hypertension (WCHT), MHT, or normotension (NT) were determined. Demographic and laboratory findings, office and ABPM measurements, blood pressure variability (BPV), and heart rate variability (HRV) were compared between the groups. The factors predicting MHT and the association between LVMI and ABPM, BPV/HRV parameters were analyzed.

Results None of the 118 patients (M/F: 52/66) had WCHT. Three groups were formed: AHT (n: 60, 51%), MHT (n: 46, 39%), and NT (n: 12, 10%). Striae were significantly more frequent in AHT and MHT groups (P: 0.003). Cut-off levels for office BP measurements predicting MHT were 0.85 and 0.76 for systolic and diastolic BP (SBP and DBP) indexes, respectively. Most of the ABPM parameters of MHT group were as high as those of AHT group. On regression analysis, only daytime MAP had a positive (β: 0.340; P < 0.01) and diastolic dip (β: −0.204; P < 0.01) had a significantly negative association with LVMI.

Conclusion Stria and cut-off levels for office SBP/DBP indexes, which were defined for the first time in this study, may determine the patients at risk of MHT. Although BPV or HRV had no relation to LVMI, daytime MAP and diastolic dip represented independent associations with LVMI.

aDepartment of Pediatrics

bDepartment of Pediatrics Division of Nephrology, İzmir Tepecik Training and Research Hospital

cDepartment of Pediatrics Division of Nephrology, İzmir Katip Çelebi University

dDepartment of Pediatrics Division of Endocrinology, İzmir Tepecik Training and Research Hospital

eDepartment of Pediatrics Division of Endocrinology

fDepartment of Biostatistics, İzmir Katip Çelebi University, İzmir, Turkey

* Gökçe Yegül Gülnar and Belde Kasap Demir contributed equally to the writing of this article.

* Nejat Aksu deceased.

Received 29 May 2018 Accepted 1 August 2019

Correspondence to Belde Kasap-Demir, MD, Department of Pediatrics, Division of Pediatric Nephrology, İzmir Katip Çelebi University, İzmir, Türkiye, Tel: +90 532 5034675; fax: +90 232 433 07 56; e-mail:

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