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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
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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: gstergi@med.uoa.gr

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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins