Key result
Office blood pressure percentiles showed moderate predictive ability for ambulatory hypertension (AUC 0.773 for systolic), but misclassified over half of office-hypertensive obese children as having white coat hypertension.
Why the study?
Obese children are predisposed to hypertension, but data characterizing their blood pressure using ambulatory blood pressure monitoring (ABPM) are scarce, especially in the developing world.
Can office blood pressure optimally predict ambulatory hypertension in obese children?
Cross-Sectional (n=55)
No
Can office blood pressure optimally predict ambulatory hypertension in obese children?
Effect estimate: AUC 0.773 (95% CI 0.619-0.926)
p-value: p=0.005
Office blood pressure does not optimally predict ambulatory hypertension in obese children, highlighting the high prevalence of white coat hypertension and the necessity of ABPM before initiating pharmacotherapy.
Office BP inaccurately predicts ambulatory hypertension in obese children; leaves open whether routine ABPM alters long-term cardiovascular outcomes.
Background: The epidemic of obesity along with hypertension (HT) and cardiovascular disease is a growing contributor to global disease burden. It is postulated that obese children are predisposed to hypertension and subsequent cardiovascular disease in adulthood. Early detection and management of hypertension in these children can significantly modify the course of the disease. However, there is paucity of studies for characterization of blood pressure in obese children through ambulatory blood pressure monitoring (ABPM), especially in the developing world. This study aims to characterize ambulatory blood pressure in obese children along with calculation of cut offs for office BP that will predict ambulatory hypertension. Methods: In the present study, 55 children with body mass index (BMI) ≥95th percentile for age and sex were enrolled in a tertiary care hospital who underwent 24 hours ABPM and detailed biochemical investigations. Results: Ambulatory hypertension was recorded in 14/55 (25.5%; white coat hypertension in 17/29(58.6%)and masked hypertension in 2/26 (7.69)%. For office SBP percentile the area under curve (AUC) was 0.773 (95% CI: 0.619 to 0.926, p=0.005) and for office DBP percentile, the AUC was 0.802 (95% CI: 0.638 to 0.966, p=0.002). The optimal cut offs for office blood pressure which predicts ambulatory hypertension in obese children were 93rd percentile for systolic BP (sensitivity-67% and specificity -78%) and 88th percentile for diastolic BP (sensitivity-83% and specificity -62%). Conclusion: Ambulatory blood pressure abnormalities are highly prevalent among children with obesity. Office blood pressure did not optimally predict ambulatory hypertension. More than half of the children labelled as ‘hypertension’ on office blood pressure measurement in the study were diagnosed to have white coat hypertension (WCH), thus emphasizing the role of ABPM for evaluation of WCH before the child is subject to detailed investigations or started on pharmacotherapy
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Bhatt et al. (2020) conducted a cross-sectional in Obesity and Hypertension (n=55). Office blood pressure measurement vs. Ambulatory blood pressure monitoring was evaluated on Prediction of ambulatory hypertension based on office systolic blood pressure percentile (AUC 0.773, 95% CI 0.619-0.926, p=0.005). Office blood pressure percentiles showed moderate predictive ability for ambulatory hypertension (AUC 0.773 for systolic), but misclassified over half of office-hypertensive obese children as having white coat hypertension.
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