AMBULATORY BLOOD-PRESSURE MONITORING IN C HILDREN AND ADOLESCENTS WITH ARTERIAL-HYPERTENSION

Background: Ambulatory blood pressur monitoring is increasingly used i n adults, as it gives more insight into the individual cardiovascular risk of hypertensive patients than casual measurements. It detects pat hological changes of the circadian variation of blood pressure, which may be disturbed in secondary and severe forms of primary hypertension . Now this method can also be applied in children. Method: Ambulatory monitoring of blood pressure over 24 hours was performed in 108 childr en with renal, endocrine and cardiovascular hypertension or just eleva ted casual blood pressure. Results: In 39 of 108 patients daily blood pressure values above the 95th centile of healthy children were found. 24 patients had a disturbed circadian pattern with a blunted drop or a paradox rise of blood pressure at night. If blood pressure values at night were considered, too, 54 of the 108 patients were hypertensive. 15 patients had elevated blood pressure on ambulatory monitoring, whi le casual values were normal. On the other hand 14 pathological casual values turned put to be normal during ambulatory monitoring. The inci dence of target organ damage, i.e. cardiac hypertrophy and hypertensiv e retinopathy, correlated with elevated blood pressure levels at day a nd at night and with a decreased drop at night, but not with casual me asurements. Conclusion: Ambulatory blood pressure monitoring character izes better than casual measurements the risk of target organ damage a nd reveals nighttime hypertension. It should therefore be performed in all children and adolescents with secondary hypertension or elevated casual blood pressure.