White-Coat Hypertension

ABPM is useful to diagnose white-coat hypertension (WCH). WCH is defined as BP levels that are at the 95th percentile or higher when measured in the physician’s office but completely normal (average BP less than 90th percentile) outside of the clinical setting. Office measurements often fail to account for this transient, stress-induced elevation of BP. Ambulatory BP monitoring has an important role in this determination.

Children and adolescents with WCH have increased body mass index (BMI) and a tendency toward elevated LVM index, thereby strengthening the suggestion for clinical ABPM follow-up of WCH.

The major limitations to the use of ABPM in children are uncertainty about normative BP measures, difficulty in defining ambulatory HTN, technical limitations, and costs.

(From Flynn et al, Hypertension 2014; 63: 1116-1135)

16 Year Old Example This is a 16 year old with mild unrepaired coarctation of the aorta and bicuspid aortic valve who had mean BP of 130-135 mmHg systolic and 80-85 mmHg diastolic in the right upper limb seated by repeat manual auscultation at separate visits.

16 Year Old Example

This is a 16 year old with mild unrepaired coarctation of the aorta and bicuspid aortic valve who had mean BP of 130-135 mmHg systolic and 80-85 mmHg diastolic in the right upper limb seated by repeat manual auscultation at separate visits.

The patient is a wrestler and wants to play football. He admits that doctor’s visits make him nervous.

The 24-hour ABPM is shown below. Ambulatory limits of blood pressure for this study are set at 135/83 mm Hg (awake) and 120/66 mm Hg (asleep). Awake and sleep times were recorded by the patient.

Summary sheet for 24-hour ABPM study:

SD = Standard Deviation

Impression/Plan:

Normal ABPM study indicating that this patient has white-coat hypertension. He is cleared for dynamic sports participation. However, it is still recommended that he avoid exercises such as power weight lifting and wrestling (isometric exercise).