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 ( R 2 =0.22, beta±s.e. =0.06±0.01), whereas LVM was determined ( R 2 =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.