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Persistence and determinants of blood pressure phenotypes according to office and ambulatory blood pressure measurements in youth

Hypertension Research volume 46, pages 1257–1266 (2023)Cite this article

Abstract

Ambulatory BP monitoring is increasingly used in children and adolescents, and the persistence of discrepant phenotypes, such as white coat or masked hypertension, is a relevant issue. The objective of this study was to assess the persistence of BP phenotypes over time and the factors related to their persistence. The study included 582 children and adolescents (9.4  ±  2.8 years of age) of both sexes (51% females) referred for routine health maintenance. Anthropometric parameters and office and 24-h ABPM measurements were obtained twice (interval 19.5  ±  6.9 months). BP classification and phenotypes were qualified using the 2016 ESH Guidelines. The correlation coefficient and kappa statistics were used to assess the persistence of phenotypes, and the related factors were evaluated using logistic regression. Based on both systolic and diastolic BP measurements, 91.6%, 16%, 17.2% and 13.7% of the subjects with true normotension, sustained HTN, white coat HTN and masked HTN, respectively, remained in the same category (overall agreement 74.2%, kappa 0.20). The multivariate model predicted the lack of persistence and correctly classified 90.3% of the subjects, with the pathological baseline BP phenotype (mainly masked HTN) being the independent variable that contributed most to the model. Excluding the phenotypes, the rest of the model explained 14% of the lack of persistence, and a high office SBP and high waist circumference were related to the lack of persistence. Furthermore, subjects who experienced an increase in their BMI z score and change in their BMI category were at risk of a lack of persistence. In conclusion, children, especially those with BP phenotypes different from true normotension, should be re-evaluated because a large percentage are likely to become normotensive.

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Acknowledgements

We acknowledge the expert assistance of Christine Deutsch.

Funding

The study was partially funded by the Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CB06/03), Ministerio de Ciencia, Innovación y Universidades (Grant Number PI20/00269), Instituto de Salud Carlos III and cofinanced by the European Regional Development Fund (to EL). This study was funded by the Instituto de Salud Carlos III (ISCIII) through the project INTEGRActiv, Project title “Identification and validation of integrative biomarkers of physical activity level and health in children and adolescents” and co-funded by Next Generation EU, Mecanismo para la Recuperación y la Resiliencia (MRR). This publication is based upon the work of the COST Action HyperChildNET (CA19115), with the support of COST (European Cooperation in Science and Technology). Fernando Martinez received the support of a Virtual Mobility from COST Action HyperChildNET (CA19115), Identification number E-COST-GRANT-CA19115-5923465e.

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Authors and Affiliations

  1. Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain

    Fernando Martinez & Josep Redon

  2. Internal Medicine Hospital Clínico of Valencia, Valencia, Spain

    Fernando Martinez

  3. CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain

    Josep Redon, Francisco Aguilar & Empar Lurbe

  4. Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain

    Francisco Aguilar, José Miguel Calderon & Empar Lurbe

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  1. Fernando Martinez
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Correspondence to Empar Lurbe.

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Martinez, F., Redon, J., Aguilar, F. et al. Persistence and determinants of blood pressure phenotypes according to office and ambulatory blood pressure measurements in youth. Hypertens Res 46, 1257–1266 (2023). https://doi.org/10.1038/s41440-022-01159-w

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