Background: Arterial hypertension (AH) is one of the most common and the earliest complications of childhood obesity. It is diagnosed on the basis of at least three results of the standard setting measurements of systolic (SBP) and diastolic (DBP) blood pressure. Nevertheless, some data suggest, that this diagnostic standard may be not sufficient for obese children, because some BP abnormalities, unique for these patients, (decrease of night dip, elevated SBP/DBP load) cannot be recognized on the basis of the standard AH definition. Therefore an alternative, supplementary diagnostic method is needed.
Objective and hypotheses: Assessment of the usefulness of ABPM in the diagnosis of BP disorders in obese children and adolescents with (47) or without (83) previously diagnosed AH.
Method: In 130 (58 boys) obese (mean BMI SDS 4.54, 95% CI 4.24.8) patients at the mean age of 13.3 years (95% CI 12.813.7), standard blood pressure measurements and ABPM (BP Monitor Spacelabs 90217, USA) were performed.
Results: Out of 47 patients (36%) diagnosed with AH 29 (22%) and 5 (3.6%) presented with isolated SBP and DBP AH respectively. In 92 (70.8%) patients the results of ABPM were abnormal, however only 35 (26.9%) were previously diagnosed with HA. Elevated (>2.0 S.D.) 24-h mean arterial BP was diagnosed in 7 (5.4%) patients, and only in three with AH. An elevated SBP and DBP load were observed in 39 (16%) and 19 (14.6%) patients respectively; only 20 and ten respectively met criteria for AH. The decrease (<10%) of the night time dip was present in 69 (53%) of the patients, and only 20 of them were diagnosed with AH.
Conclusion: The majority of obese children and adolescents have an abnormal BP profile, that can be not recognized on the basis of the standard setting BP measurements. Therefore ABPM should be considered as a supplementary method in the diagnosis AH in obese pediatric patients.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology