Sorof J M, Portman R J
Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, School of Medicine, University of Texas-Houston, 77030, USA.
J Pediatr. 2000 Oct;137(4):493-7. doi: 10.1067/mpd.2000.108394.
We reviewed our experience using ambulatory blood pressure monitoring (ABPM) in children referred to a hypertension clinic to determine the frequency of pediatric white coat hypertension (WCH).
WCH was defined by 3 different diagnostic criteria: (1) mean 24-hour blood pressure (BP) less than Task Force-defined 95th percentile, (2) mean 24-hour BP less than 95th percentile from pediatric normative ABPM data, and (3) mean 24-hour BP less than ABPM 95th percentile and BP load (percentage of BP readings during 24-hour period exceeding the 95th percentile) less than 25%.
Clinic BP values were available in 67 otherwise healthy children who underwent ABPM; 51 had confirmed clinic hypertension by Task Force criteria. WCH frequency in these 51 patients with the stated criteria was 53%, 45%, and 22%, respectively. Elevated BP load was found in 52% (12/23) of patients with normal mean BP.
These results suggest that many children referred for casual BP elevation have WCH even by strict diagnostic criteria. ABPM may help differentiate WCH from persistent hypertension, thereby avoiding unnecessary diagnostic evaluation and identifying children most likely to benefit from early intervention.
我们回顾了在高血压门诊接受动态血压监测（ABPM）的儿童的相关经验，以确定儿童白大衣高血压（WCH）的发生率。
WCH由3种不同的诊断标准定义：（1）24小时平均血压（BP）低于工作组定义的第95百分位数；（2）24小时平均BP低于儿科ABPM标准数据的第95百分位数；（3）24小时平均BP低于ABPM第95百分位数且血压负荷（24小时期间超过第95百分位数的血压读数百分比）低于25%。
67名接受ABPM的健康儿童有门诊血压值；51名根据工作组标准确诊为门诊高血压。这51例患者中符合上述标准的WCH发生率分别为53%、45%和22%。平均BP正常的患者中52%（12/23）存在血压负荷升高。
这些结果表明，即使采用严格的诊断标准，许多因偶然血压升高就诊的儿童患有WCH。ABPM可能有助于区分WCH和持续性高血压，从而避免不必要的诊断评估，并识别出最可能从早期干预中获益的儿童。
