Written by Hannah Harp
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Adolescent patients with ambulatory hypertension (in office and 24-hour monitoring) or masked hypertension (normal in office, elevated on 24-hour monitoring) had a more cardiovascular damage on echo.
Silent pressure, silent damage
Signs of cardiovascular changes secondary to hypertension occur early and can be detected in adolescents, making blood pressure measurement an important part of the cardiovascular risk profile even in pediatric patients. In-clinic blood pressure measurements are frequently falsely elevated, either because of incorrect measurement or because of white coat hypertension. Ambulatory blood pressure monitoring gives a more thorough picture of a patient’s blood pressure profile.
This cross-sectional SHIP-AHOY study evaluated whether ambulatory blood pressure phenotypes predict cardiovascular target organ damage in adolescents. Among 373 youth, masked and ambulatory hypertension were significantly associated with subclinical dysfunction – as quantified by left ventricular mass, systolic and diastolic cardiac function, and arterial stiffness – after adjusting for BMI and demographics. In contrast, white coat and normotensive phenotypes showed minimal abnormalities. Limitations include relatively small numbers in the masked and ambulatory hypertension groups, so future studies that recruit more patients with hypertension or other risk factors for hypertension would be helpful.
How this does change my practice?
Getting an accurate blood pressure reading on a pediatric patient while on a strict schedule is difficult at best and impossible at worst. Luckily, it gets easier as kids get older and are less scared of the BP machine… but then white coat hypertension becomes a huge issue. For kids with persistently elevated readings, I’ll be more mindful about referring for ambulatory BP monitoring, which has got to be faster than referral for a full cardiology consult.
Source
Ambulatory Blood Pressure Phenotype and Cardiovascular Risk in Youth: The SHIP-AHOY Study. J Pediatr. 2025 Apr 17;282:114601. doi: 10.1016/j.jpeds.2025.114601. Epub ahead of print. PMID: 40252956
