Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The objective of this study was to present our data on ambulatory blood pressure monitoring (ABPM) in children and adolescents referred to our Department because of casual BP elevation over the 95th percentile on at least 3 visits in primary care office. ABPM studies in 139 children, 94 boys and 45 girls, mean age 14.14 (range 4-19) years, were reviewed. A total of 107 (76.98%) children had hypertension according to the ABPM criteria. Primary hypertension (PH) was diagnosed in 89 (64.03%), secondary hypertension (SH) in 18 (12.95%) and white coat hypertension (WCH) in 32 (23.02%) children. In both PH and SH groups, hypertension was predominantly systolic (60.67% and 55.56%, respectively). There was no statistically significant difference in diurnal and nocturnal systolic and diastolic blood pressure (BP) loads between PH and SH groups. The non-dipping phenomenon was detected in 49.44%, 66.66% and 40.62% of children with PH, SH and WCH, respectively. The mean pulse pressure values were 60.41, 58.58 and 52.25 mm Hg in the PH, SH and WCH groups, respectively. A statistically significant difference was found in pulse pressure values between PH and WCH (df=55, t=6.15, p<0.01) groups and between SH and WCH groups (df=31, t=3.18, p=0.001). Target organ damage was diagnosed in 16 (17.98%) children with PH and in 5 (27.78%) children with SH. None of the children with WCH had target organ damage. ABPM is indispensable for establishing the diagnosis of hypertension in children. It is the only reliable method of WCH diagnosis.Cilj istraživanja bio je prikazati naše rezultate kontinuiranog mjerenja arterijskog tlaka (KMAT) u djece i adolescenata upućenih u našu Kliniku zbog povišenog krvnog tlaka (BP) iznad 95. percentile izmjerenog u ordinacijama liječnika primarne zdravstvene zaštite u 3 ili više navrata. Analizirali smo rezultate KMAT-a u 139 djece, 94 dječaka i 45 djevojčica. Srednja dob bila je 14,14 (4-19) godina. Prema nalazu KMAT-a 107 (76,98%) djece imalo je hipertenziju. Primarna hipertenzija (PH) utvrđena je u 89 (64,03%), sekundarna hipertenzija (SH) u 18 (12,95%) i hipertenzija bijele kute (WCH) u 32 (23,02%) djece. I u PH i u SH radilo se većinom o sistoličnoj hipertenziji (60,67% odnosno 55,56%). Nije bilo statistički značajne razlike u vrijednostima postotka povišenog krvnog tlaka iznad 95. centile (engl. BP load) između dnevnog i noćnog sistoličnog i dijastoličnog tlaka između PH i SH. Fenomen non-dipping utvrđen je u 49,44% djece s PH, 66,66% djece sa SH te 40,62% djece s WCH. Srednja vrijednost tlaka pulsa bila je 60,41 mm Hg u PH, 58,58 mm Hg u SH i 52,25 mm Hg u WCH. Statistički značajna razlika nađena je u tlaku pulsa između PH i WCH (df=55, t=6,15, p<0,01), te između SH i WCH (df=31, t=3,18, p=0,001). Oštećenje ciljnih organa ustanovljeno je kod 16 (17,98%) djece s PH i 5 (27,78%) djece sa SH. Oštećenje ciljnih organa nije ustanovljeno kod djece s WCH. KMAT je neophodan za dijagnosticiranje hipertenzije u djece i predstavlja jedinu pouzdanu metodu za dijagnosticiranje WCH
