White-coat hypertension and masked hypertension in children

The use of ambulatory blood pressure monitoring in addition to the conventional office measurements makes possible the detection of individuals with white-coat hypertension and masked hypertension. In children referred for elevated blood pressure, both these phenomena appear to be common (10-15% for each). In a population of healthy children, white-coat hypertension appears to be as common as hypertension, whereas masked hypertension appears to be more common than white-coat hypertension or hypertension. In children with persistent white-coat or masked hypertension, assessment of target organ damage by echocardiography is required. Preliminary evidence suggests that, in contrast to white-coat hypertension, which is not associated with target organ damage, masked hypertension in children is associated with increased left ventricular mass. Children with masked hypertension should be followed up and possibly treated for hypertension if the phenomenon persists or there is evidence of target organ damage.