Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children
Introduction. Given the significant levels of pediatric excess weight worldwide, we sought to identify the prevalence of abnormally high BP levels (based on auscultatory measurements and ambulatory blood pressure monitoring – ABPM) in a cohort of excess weight children compared to normal weight con...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Amaltea Medical Publishing House
2020-06-01
|
| Series: | Romanian Journal of Pediatrics |
| Subjects: | |
| Online Access: | https://rjp.com.ro/articles/2020.2/RJP_2020_2_EN_Art-05.pdf |
| _version_ | 1818398190271987712 |
|---|---|
| author | Cristina Ramona Rădulescu Ioana Adriana Ghiorghiu Ana-Maria Berchimiş Mihaela Dăscălaşu Gabriela Vlad Doina Anca Pleşca |
| author_facet | Cristina Ramona Rădulescu Ioana Adriana Ghiorghiu Ana-Maria Berchimiş Mihaela Dăscălaşu Gabriela Vlad Doina Anca Pleşca |
| author_sort | Cristina Ramona Rădulescu |
| collection | DOAJ |
| description | Introduction. Given the significant levels of pediatric excess weight worldwide, we sought to identify the prevalence of abnormally high BP levels (based on auscultatory measurements and ambulatory blood pressure monitoring –
ABPM) in a cohort of excess weight children compared to normal weight controls and to analyze the effect of weight loss on BP measurements in the excess weight group.
Method. 46 excess weight children and 28 normal weight controls underwent clinical examination, routine blood tests and lipid profile, 12-lead ECG, ABPM and echocardiography. For the excess weight group lifestyle advice was provided and children were subsequently followed up for 12 months.
Results. The auscultatory method yielded high rates of arterial hypertension (HTN) (50-58% in the study group and 22-33% in the control group). There was a statistically significant difference in HTN prevalence between the two
groups regardless of the standard used to define it. BMI-for-age correlated positively with HTN. The corresponding BP category was generally higher when applying the Unites States guideline.
There was a prevalence of HTN of 14.3% in the study group and 4% in the control group according to ABPM results
(t (51)= 1.274, p= 0.208, C.I. [-0.06, 0.26]). 48.3% of excess weight children and 56% of controls were non-dippers.
There was no significant association between dipping status and ABPM-confirmed hypertension. 64% of excess weight participants exhibited dipping status variability.
There was a small, but statistically significant improvement of BMI-for-age within the excess weight group over the follow-up period. There was however no significant drop in HTN levels. HTN prevalence remained much lower when diagnosed by means of ABPM (16.7%) than by manual measurements (42.9%).
Discussion. There was a surprisingly high prevalence of arterial hypertension based on manual measurements, mainly driven by high systolic BP values. The numbers decreased significantly after ABPM-based reclassification.
Another unexpected find was the high proportion of non-dippers in both groups, which could be partially explained by fragmented, poor quality sleep during monitoring.
Conclusions. We found an unexpectedly high prevalence of increased BP levels for age when using manual, in-office measurements only. Ambulatory BP monitoring with pediatric approved devices has proved extremely useful in refining the diagnosis and should thus be employed for confirmation if available.
There was an increased prevalence of hypertension in the excess weight group and BMI-for-age correlated positively with BP values. We were unable to demonstrate a reduction in BP levels with improved nutritional status, however we believe this may be achieved with an adequately sized cohort and more stringent lifestyle intervention. |
| first_indexed | 2024-12-14T07:00:51Z |
| format | Article |
| id | doaj.art-4391341741fb44448c5cb50264604091 |
| institution | Directory Open Access Journal |
| issn | 1454-0398 2069-6175 |
| language | English |
| last_indexed | 2024-12-14T07:00:51Z |
| publishDate | 2020-06-01 |
| publisher | Amaltea Medical Publishing House |
| record_format | Article |
| series | Romanian Journal of Pediatrics |
| spelling | doaj.art-4391341741fb44448c5cb502646040912022-12-21T23:12:25ZengAmaltea Medical Publishing HouseRomanian Journal of Pediatrics1454-03982069-61752020-06-0169210310710.37897/RJP.2020.2.5Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight childrenCristina Ramona Rădulescu0Ioana Adriana Ghiorghiu1Ana-Maria Berchimiş2Mihaela Dăscălaşu3Gabriela Vlad4Doina Anca Pleşca5“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; “Dr. Victor Gomoiu” Clinical Children’s Hospital, Bucharest, Romania“Dr. Victor Gomoiu” Clinical Children’s Hospital, Bucharest, Romania; Ponderas Academic Hospital, Bucharest, Romania“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; “Dr. Victor Gomoiu” Clinical Children’s Hospital, Bucharest, Romania; Ponderas Academic Hospital, Bucharest, Romania “Dr. Victor Gomoiu” Clinical Children’s Hospital, Bucharest, Romania1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; “Dr. Victor Gomoiu” Clinical Children’s Hospital, Bucharest, RomaniaIntroduction. Given the significant levels of pediatric excess weight worldwide, we sought to identify the prevalence of abnormally high BP levels (based on auscultatory measurements and ambulatory blood pressure monitoring – ABPM) in a cohort of excess weight children compared to normal weight controls and to analyze the effect of weight loss on BP measurements in the excess weight group. Method. 46 excess weight children and 28 normal weight controls underwent clinical examination, routine blood tests and lipid profile, 12-lead ECG, ABPM and echocardiography. For the excess weight group lifestyle advice was provided and children were subsequently followed up for 12 months. Results. The auscultatory method yielded high rates of arterial hypertension (HTN) (50-58% in the study group and 22-33% in the control group). There was a statistically significant difference in HTN prevalence between the two groups regardless of the standard used to define it. BMI-for-age correlated positively with HTN. The corresponding BP category was generally higher when applying the Unites States guideline. There was a prevalence of HTN of 14.3% in the study group and 4% in the control group according to ABPM results (t (51)= 1.274, p= 0.208, C.I. [-0.06, 0.26]). 48.3% of excess weight children and 56% of controls were non-dippers. There was no significant association between dipping status and ABPM-confirmed hypertension. 64% of excess weight participants exhibited dipping status variability. There was a small, but statistically significant improvement of BMI-for-age within the excess weight group over the follow-up period. There was however no significant drop in HTN levels. HTN prevalence remained much lower when diagnosed by means of ABPM (16.7%) than by manual measurements (42.9%). Discussion. There was a surprisingly high prevalence of arterial hypertension based on manual measurements, mainly driven by high systolic BP values. The numbers decreased significantly after ABPM-based reclassification. Another unexpected find was the high proportion of non-dippers in both groups, which could be partially explained by fragmented, poor quality sleep during monitoring. Conclusions. We found an unexpectedly high prevalence of increased BP levels for age when using manual, in-office measurements only. Ambulatory BP monitoring with pediatric approved devices has proved extremely useful in refining the diagnosis and should thus be employed for confirmation if available. There was an increased prevalence of hypertension in the excess weight group and BMI-for-age correlated positively with BP values. We were unable to demonstrate a reduction in BP levels with improved nutritional status, however we believe this may be achieved with an adequately sized cohort and more stringent lifestyle intervention.https://rjp.com.ro/articles/2020.2/RJP_2020_2_EN_Art-05.pdfexcess weighthypertensionauscultatoryoscillometricabpmdipper |
| spellingShingle | Cristina Ramona Rădulescu Ioana Adriana Ghiorghiu Ana-Maria Berchimiş Mihaela Dăscălaşu Gabriela Vlad Doina Anca Pleşca Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children Romanian Journal of Pediatrics excess weight hypertension auscultatory oscillometric abpm dipper |
| title | Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children |
| title_full | Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children |
| title_fullStr | Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children |
| title_full_unstemmed | Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children |
| title_short | Ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children |
| title_sort | ambulatory blood pressure monitoring greatly improves diagnostic accuracy in excess and normal weight children |
| topic | excess weight hypertension auscultatory oscillometric abpm dipper |
| url | https://rjp.com.ro/articles/2020.2/RJP_2020_2_EN_Art-05.pdf |
| work_keys_str_mv | AT cristinaramonaradulescu ambulatorybloodpressuremonitoringgreatlyimprovesdiagnosticaccuracyinexcessandnormalweightchildren AT ioanaadrianaghiorghiu ambulatorybloodpressuremonitoringgreatlyimprovesdiagnosticaccuracyinexcessandnormalweightchildren AT anamariaberchimis ambulatorybloodpressuremonitoringgreatlyimprovesdiagnosticaccuracyinexcessandnormalweightchildren AT mihaeladascalasu ambulatorybloodpressuremonitoringgreatlyimprovesdiagnosticaccuracyinexcessandnormalweightchildren AT gabrielavlad ambulatorybloodpressuremonitoringgreatlyimprovesdiagnosticaccuracyinexcessandnormalweightchildren AT doinaancaplesca ambulatorybloodpressuremonitoringgreatlyimprovesdiagnosticaccuracyinexcessandnormalweightchildren |