Repeated ambulatory blood pressure monitoring in adolescents with mild hypertension.

The reproducibility of serial measurements of ambulatory blood pressure monitoring (ABPM) has not been well explored in children. We performed 24-h ABPM in 59 subjects (38 boys) aged 8-19 years with repeatedly elevated casual blood pressure (BP). According to the results of ABPM, the individuals were divided into a hypertensive group (mean 24-h systolic or diastolic BP >95th percentile for height, n=28) and a normotensive group (n=31). No antihypertensive agents were given. Both groups were reexamined after 1 year. In the hypertensive group, systolic and diastolic BP dropped significantly by an average of 2.1-4.5 mmHg when measured either during the daytime or over 24 h, but not at nighttime. In the normotensive group, only small BP changes were observed except for a significant increase in systolic BP at night. At the repeat examination after 1 year, 54% of the originally hypertensive subjects were defined as normotensive and 23% of the originally normotensive subjects as hypertensive. The study indicates that a single ABPM measurement is not sufficient for definitive classification of young individuals into hypertensives or normotensives.

[Changes in left ventricular geometry in children and adolescents with primary hypertension]. / Zmeny geometrie levé komory u detí a adolescentu s primární hypertenzí.

BACKGROUND: Left ventricular hypertrophy is an independent risk factor of cardiovascular morbidity and mortality in adults. The results of 24-hour ambulatory blood pressure monitoring (ABPM) correlate better with signs of organ damage than values of casual blood pressure. The objective of this study was to investigate the relationships between the results of 24-hour ABPM and left ventricular geometry in school-aged children and adolescents with elevated blood pressure. METHODS AND RESULTS: 24-hour ABPM and echocardiographic assessment of left ventricle were performed in 108 children and adolescents age 8-20 years (77 boys and 31 girls) with repeatedly elevated casual blood pressure (BP) values. Patients with secondary cause of hypertension were not included in this study. Based on ABPM results 57 patients out of total 108 had hypertension, the rest of 51 subjects had their ambulatory BP values below 95. percentil and were labelled as white coat hypertensive (WCH). The left ventricular measurements in hypertensive subject were higher when compared with WCH (left ventricle posterior wall thickness 8.4 +/- 1.0 mm in hypertensive vs. 8.0 +/- 1.1 mm in WHC (p = 0.047) and superscript left ventricular mass index 81.8 +/- 13.8 g/m2 vs 74.3 +/- 12 g/m2 respectively; p = 0.003). No differences were found in anthropometric data including body mass index in both groups. There was a significant correlation between ambulatory BP and both left ventricle posterior wall thickness and left ventricular mass index. The strongest correlation was found between diurnal systolic ambulatory BP and left ventricle posterior wall thickness (r = 0.42; p < 0.001) as well as between 24-hour and diurnal systolic ambulatory BP and left ventricular mass index (both r = 0.47; p < 0.001). CONCLUSIONS: Both left ventricle posterior wall thickness a left ventricle mass index are higher in patients with hypertension documented by ABPM compared with WCH subjects. The strongest correlation was found between diurnal systolic ambulatory BP and both left ventricle posterior wall thickness and left ventricular mass index.

[Ambulatory monitoring of blood pressure--focus on childhood]. / Ambulantní monitorování krevního tlaku--zaostreno na detský vek.

Conventional office measurements of blood pressure (BP) are limited in their ability to assess long term hemodynamic load on cardiovascular system. The ambulatory blood pressure monitoring (ABPM) offers the advantage of providing multiple blood pressure measurements from a subject's normal environment during his normal activities, thereby revealing important patterns of blood pressure during the whole 24-hour period. Results of ABPM have much better correlation with end organ damage than casual BP and provide more sensitive data of ultimate prognosis. There is much better long-term reproducibility of ambulatory blood pressure compared with conventional office BP measurements. The phenomenon of "white coat" hypertension (WCH) defined as mean office BP readings in the hypertensive range but ambulatory blood pressure (ABP) readings in the normal range represents probably a benign entity not requiring pharmacological treatment. Based on normal population of school children and adolescents the percentiles of ABP have been recently established and patterns of ABP have been studied in children in various clinical settings. WCH has been recognized in childhood and its prevalence seems to be higher comparing with adult population. ABPM seems to be an effective and well tolerated tool in evaluating BP in children and adolescents helping to identify those who need careful checkup and treatment.

[Erythema nodosum after salmonella gastroenteritis]. / Erythema nodosum po salmonelové gastroenteritide.

The author describes a case of erythema nodosum which developed after Salmonella gastroenteritis in a 7,5-year-old boy. Other known causes of this skin lesion are discussed.