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Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis

Kollias, Anastasios; Dafni, Maria; Poulidakis, Emmanouil; Ntineri, Angeliki; Stergiou, George S.

doi: 10.1097/HJH.0000000000000384

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/m2.7 (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.

Supplemental Digital Content is available in the text

Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, Sotiria Hospital, University of Athens, Athens, Greece

Correspondence to George S. Stergiou, Professor, MD, FRCP, Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, Sotiria Hospital, University of Athens, 152 Mesogion Avenue, Athens 11527, Greece. Tel: +30 2107763117; fax: +30 2107719981; e-mail:

Abbreviations: BP, blood pressure; IMT, intima–media thickness; LVMI, left ventricular mass index

Received 12 April, 2014

Revised 8 August, 2014

Accepted 8 August, 2014

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