Relationship of home blood pressure with target-organ damage in children and adolescents

The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13±3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1±15.1/71±12.9 mm Hg (systolic/diastolic), HBP 121.3±11.5/69.4±6.6 mm Hg and 24-h ABP 118.9±12/66.6±6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r=0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all P<0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r=0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all P<0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r=0.30 and 0.28, respectively, P<0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R2=0.22, beta±s.e. =0.06±0.01), whereas LVM was determined (R2=0.67) by 24-h pulse pressure (beta=1.21±0.41), age (beta=2.93±1.32), 24-h heart rate (beta=−1.27±0.41) and BMI (beta=1.78±0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.