Published Online
on June 25, 2007

A more recent version of this article appeared on August 1, 2007

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Submitted on April 16, 2007
Revised on May 15, 2007

Left Ventricular Hypertrophy in Hypertensive Adolescents. Analysis of Risk by 2004 National High Blood Pressure Education Program Working Group Staging Criteria

Karen L. McNiece^*; Monesha Gupta-Malhotra; Joshua Samuels; Cynthia Bell; Kathleen Garcia; Timothy Poffenbarger; Jonathan M. Sorof; and Ronald J. Portman

From the Department of Pediatrics, Division of Pediatric Nephrology and Hypertension (K.L.M., J.S., C.B., T.P., R.J.P.), and Department of Pediatrics, Division of Pediatric Cardiology (M.G.-M.), School of Medicine, University of Texas, Houston; Wyle Laboratories (K.G.), Houston, Tex; and AstraZeneca Pharmaceuticals, Wilmington, Del (J.M.S.).

^* To whom correspondence should be addressed. E-mail: karen.l.mcniece{at}uth.tmc.edu.

Abstract--The National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents recently recommended staging hypertension (HTN) in children and adolescents based on blood pressure severity. The use of blood pressure staging and its corresponding therapeutic approach was examined in this pooled analysis assessing the risk for end-organ damage, specifically left ventricular hypertrophy among hypertensive adolescents stratified by working group criteria. Newly diagnosed hypertensive adolescents and normotensive control subjects similar in age, race/ethnicity, gender, and body mass index completed casual and 24-hour ambulatory blood pressure measurements, M-mode echocardiography, and fasting serum laboratories. Hypertensive subjects had higher insulin and cholesterol but similar glucose levels as compared with control subjects. Among subjects with stage 1 HTN by casual blood pressure, 34% had white-coat HTN as opposed to 15% of stage 2 hypertensive subjects. Of the subjects with normal casual measurements, 20% had HTN by ambulatory monitoring. Subjects with stage 2 HTN by casual measurement alone (odds ratio: 4.13; 95% CI: 1.04 to 16.48) and after 24-hour ambulatory confirmation (odds ratio: 7.23; 95% CI: 1.28 to 40.68) had increased odds for left ventricular hypertrophy. In addition, the risk for left ventricular hypertrophy was similar for subjects with masked and confirmed stage 1 HTN, whereas subjects with white-coat HTN had a risk comparable to normotensive subjects. Thus, recommendations that adolescents with stage 2 HTN by casual measurements alone receive medication initially along with therapeutic lifestyle counseling are reasonable, though ambulatory blood pressure monitoring remains a valuable tool for evaluating children with stage 2 HTN, because >10% have white-coat HTN.

Key words: hypertension • left ventricular hypertrophy • echocardiography • ambulatory blood pressure monitoring • white-coat hypertension • masked hypertension • adolescents

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