Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic

Patrizia Salice, Gianluigi Ardissino, Paolo Barbier, Laura Bacà, Daniela Li Vecchi, Silvia Ghiglia, Anna M. Colli, Maria A. Galli, Giuseppina Marra, Sara Testa, Alberto Edefonti, Fabio Magrini, Alberto Zanchetti

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES:: Information on ambulatory blood pressure monitoring (ABPM) in children is scarce. While in adults office BP (OBP) is higher than ABP and the difference increases as OBP increases, information in children suggests that at this young age ABP is no lower and often higher than OBP. This study was aimed at describing OBP-ABP differences in a cohort of children of different ages and BPs, and investigating whether OBP-ABP differences are dependent on age or OBP level. METHODS:: We retrospectively compared OBP and 24-h, daytime and night-time ABP in 433 children and adolescents aged 4-18 years, referred to our hospital clinic. RESULTS:: OBP was found to be significantly lower than 24-h and daytime ABP in the low age tertile (4-10 years) but not in the medium and high tertiles. OBP was also lower than ABP in normotensive patients (n = 182), but higher than ABP in untreated hypertensive patients (n =  92) despite similar ages. Continuous analyses showed a weak correlation of OBP-ABP differences with age, and a much stronger correlation with OBP so that 24-h ABP was higher than OBP at OBP values less than 117/73 mmHg and lower than OBP at higher OBP values. Logistic regression analysis indicates that also in children OBP accounts for most of the OBP-ABP difference. CONCLUSION:: There is a common relation both in children and adults between OBP and ABP. It is only because high OBP is common in the elderly, and the lowest OBP is usually found in young children that large positive OBP-ABP differences have been associated with old age, and negative differences with childhood. OBP-ABP differences, often defined as white-coat effect, can have different directions and are likely to be largely due to regression to the mean.

Original languageEnglish
Pages (from-to)2165-2175
Number of pages11
JournalJournal of Hypertension
Volume31
Issue number11
DOIs
Publication statusPublished - Nov 2013

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Blood Pressure
Hypertension
Ambulatory Blood Pressure Monitoring
Logistic Models
Regression Analysis

Keywords

  • ambulatory blood pressure
  • children hypertension
  • office blood pressure
  • office-ambulatory blood pressure difference

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic. / Salice, Patrizia; Ardissino, Gianluigi; Barbier, Paolo; Bacà, Laura; Vecchi, Daniela Li; Ghiglia, Silvia; Colli, Anna M.; Galli, Maria A.; Marra, Giuseppina; Testa, Sara; Edefonti, Alberto; Magrini, Fabio; Zanchetti, Alberto.

In: Journal of Hypertension, Vol. 31, No. 11, 11.2013, p. 2165-2175.

Research output: Contribution to journalArticle

Salice, P, Ardissino, G, Barbier, P, Bacà, L, Vecchi, DL, Ghiglia, S, Colli, AM, Galli, MA, Marra, G, Testa, S, Edefonti, A, Magrini, F & Zanchetti, A 2013, 'Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic', Journal of Hypertension, vol. 31, no. 11, pp. 2165-2175. https://doi.org/10.1097/HJH.0b013e3283643361
Salice, Patrizia ; Ardissino, Gianluigi ; Barbier, Paolo ; Bacà, Laura ; Vecchi, Daniela Li ; Ghiglia, Silvia ; Colli, Anna M. ; Galli, Maria A. ; Marra, Giuseppina ; Testa, Sara ; Edefonti, Alberto ; Magrini, Fabio ; Zanchetti, Alberto. / Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic. In: Journal of Hypertension. 2013 ; Vol. 31, No. 11. pp. 2165-2175.
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abstract = "BACKGROUND AND OBJECTIVES:: Information on ambulatory blood pressure monitoring (ABPM) in children is scarce. While in adults office BP (OBP) is higher than ABP and the difference increases as OBP increases, information in children suggests that at this young age ABP is no lower and often higher than OBP. This study was aimed at describing OBP-ABP differences in a cohort of children of different ages and BPs, and investigating whether OBP-ABP differences are dependent on age or OBP level. METHODS:: We retrospectively compared OBP and 24-h, daytime and night-time ABP in 433 children and adolescents aged 4-18 years, referred to our hospital clinic. RESULTS:: OBP was found to be significantly lower than 24-h and daytime ABP in the low age tertile (4-10 years) but not in the medium and high tertiles. OBP was also lower than ABP in normotensive patients (n{\^a}€Š={\^a}€Š182), but higher than ABP in untreated hypertensive patients (n{\^a}€Š= {\^a}€Š92) despite similar ages. Continuous analyses showed a weak correlation of OBP-ABP differences with age, and a much stronger correlation with OBP so that 24-h ABP was higher than OBP at OBP values less than 117/73{\^a}€ŠmmHg and lower than OBP at higher OBP values. Logistic regression analysis indicates that also in children OBP accounts for most of the OBP-ABP difference. CONCLUSION:: There is a common relation both in children and adults between OBP and ABP. It is only because high OBP is common in the elderly, and the lowest OBP is usually found in young children that large positive OBP-ABP differences have been associated with old age, and negative differences with childhood. OBP-ABP differences, often defined as white-coat effect, can have different directions and are likely to be largely due to regression to the mean.",
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AU - Salice, Patrizia

AU - Ardissino, Gianluigi

AU - Barbier, Paolo

AU - Bacà, Laura

AU - Vecchi, Daniela Li

AU - Ghiglia, Silvia

AU - Colli, Anna M.

AU - Galli, Maria A.

AU - Marra, Giuseppina

AU - Testa, Sara

AU - Edefonti, Alberto

AU - Magrini, Fabio

AU - Zanchetti, Alberto

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N2 - BACKGROUND AND OBJECTIVES:: Information on ambulatory blood pressure monitoring (ABPM) in children is scarce. While in adults office BP (OBP) is higher than ABP and the difference increases as OBP increases, information in children suggests that at this young age ABP is no lower and often higher than OBP. This study was aimed at describing OBP-ABP differences in a cohort of children of different ages and BPs, and investigating whether OBP-ABP differences are dependent on age or OBP level. METHODS:: We retrospectively compared OBP and 24-h, daytime and night-time ABP in 433 children and adolescents aged 4-18 years, referred to our hospital clinic. RESULTS:: OBP was found to be significantly lower than 24-h and daytime ABP in the low age tertile (4-10 years) but not in the medium and high tertiles. OBP was also lower than ABP in normotensive patients (n = 182), but higher than ABP in untreated hypertensive patients (n =  92) despite similar ages. Continuous analyses showed a weak correlation of OBP-ABP differences with age, and a much stronger correlation with OBP so that 24-h ABP was higher than OBP at OBP values less than 117/73 mmHg and lower than OBP at higher OBP values. Logistic regression analysis indicates that also in children OBP accounts for most of the OBP-ABP difference. CONCLUSION:: There is a common relation both in children and adults between OBP and ABP. It is only because high OBP is common in the elderly, and the lowest OBP is usually found in young children that large positive OBP-ABP differences have been associated with old age, and negative differences with childhood. OBP-ABP differences, often defined as white-coat effect, can have different directions and are likely to be largely due to regression to the mean.

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