The following is a summary of “Control of blood pressure in hypertensive children and adolescents assessed by ambulatory blood pressure monitoring,” published in the April 2024 issue of Pediatrics by Vigraijaroenying et al.

This study addresses a significant gap in the literature concerning assessing hypertension (HT) control in pediatric populations, an area that has yet to receive much attention. The primary objective, which is of utmost importance, was to evaluate the efficacy of hypertension control utilizing ambulatory blood pressure monitoring (ABPM) while also undertaking a comparative analysis of relevant parameters between groups exhibiting controlled and uncontrolled hypertension. The study cohort comprised hypertensive patients aged five years and older who underwent ABPM to gauge the degree of HT control. 

Comprehensive data were meticulously collected and analyzed, including demographics, office blood pressure (BP), ABPM readings, and echocardiographic findings. Controlled HT status was delineated based on the BP target recommended by the 2016 European Society of Hypertension guidelines.

The analysis of 108 patients revealed a mean age of 14.3 years with a predominant male representation (64.8%), and approximately half (51.9%) exhibited primary HT. Notably, controlled HT was identified in 41.1% and 33.3% of cases using office BP and ABPM, respectively. Further stratification based on ABPM readings indicated a significantly higher prevalence of controlled HT among those with primary HT compared to their secondary HT counterparts (44.6% vs. 21.2%, P = 0.01). Moreover, within the primary HT subgroup, individuals with controlled HT exhibited a significant reduction in BMI z-score at the last follow-up compared to those with uncontrolled HT (-0.39 vs. 0.01, P = 0.032), highlighting the importance of weight management in achieving optimal BP control and mitigating the risk of left ventricular hypertrophy (LVH).

Interestingly, primary HT emerged as a negative predictor of uncontrolled HT as determined by ABPM, underscoring the distinctive characteristics of this patient subset. ABPM demonstrated superior sensitivity (77.8% vs. 55.8%) and negative predictive value (80.9% vs. 70.8%) in predicting LVH compared to conventional office BP measurement. In conclusion, the study underscores the sobering reality that only a minority of patients with pediatric hypertension attain the BP goal as assessed by ABPM, with a predominant proportion belonging to the primary HT category. Furthermore, the findings emphasize the pivotal role of weight reduction as a cornerstone intervention for BP management in primary HT patients, offering a potential avenue for attenuating the risk of LVH and its associated complications.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04732-z