White coat hypertension in children: not rare and not benign?

The clinical significance of white coat hypertension (WCH) remains uncertain. We aimed to evaluate the target organ damage (TOD) in children with essential hypertension (HTN) and WCH. We retrospectively analyzed the body mass index (BMI) and ambulatory blood pressure monitoring (ABPM) in 183 untreated children aged 5 to 19 years who were referred for assessment of hypertension and had secondary hypertension ruled out. Left ventricular mass index (LVMi) and carotid intima media thickness (CIMT) were analyzed in a subset of 106 children. WCH was found in 54/183 children (29.5%) who had normal mean arterial pressure (MAP), MAP load, and MAP day/night ratio. However, the mean+/-SD LVMi (g/m(2.7)) was identical in HTN and WCH patients (38.2+/-10.9 vs. 37.0+/-11.3, P=.59); it exceeded the 95th percentile in 40% HTN and 36% WCH patients (NS). The mean CIMT was significantly higher compared with normal, but not different between HTN and WCH; it exceeded the 95th percentile in 26% HTN and 29% WCH patients. WCH was found in up to 30% of children referred for HTN. Patients with WCH have TOD comparable to that found in HTN patients despite similar BMI, significantly lower average BP and BP load and a well-preserved BP dipping pattern.