Prevalence of psychological and metabolic concerns in children with white coat and ambulatory hypertension

Background White Coat Hypertension (WCH), or elevated blood pressure in response to stress, is common in childhood. While studies showed that hypertension (HTN) can be associated with psychological and neurocognitive impairments, the prevalence of such concerns in children with WCH is not well studied. This study aimed to evaluate prevalence of metabolic and positive mental health screening in patients with WCH and hypothesized that those concerns are higher in patients with WCH compared to HTN, while they have less frequency of metabolic risk factors. Methods This is a single-center cross- sectional study of patients referred to the pediatric nephrology outpatient clinics to assess hypertension. All patients completed a 24-hour ambulatory blood pressure monitor and classified as HTN vs WCH. Various patient and parent-reported psychosocial screening surveys were self-administered. Results of kidney function, lipid panel, and echocardiogram were collected (if available). Descriptive analyses were used to assess psychological and metabolic factors across patients, with specific focus on assessing the differences between patients with HTN versus WCH. Results The study enrolled 552 patients (56.3% had HTN; 43.7% had WCH), and of the included patients: 472 completed the screening surveys (54.2% with HTN; 43.8% with WCH). There were no significant differences between groups across metabolic risk factors of primary HTN. Furthermore, there were no significant differences in prevalence of psychological markers between the groups; however, the general prevalence across all patients with screening positive for at least one mental health concern was high at 50.1%. Conclusions Metabolic and mental health concerns, including inattention, anxiety, and depression are common in patients with WCH at a similar rate to HTN. This highlights the importance of considering psychosocial functioning testing when treating pediatric patients with hypertension disorders.