Diagnosis of masked hypertension in children – the role of self-measured blood pressure

Masked hypertension (MH) in children is defined as having office blood pressure (BPoff) below the 95th percentile and ambulatory blood pressure monitoring (ABPM) values at or above the 95th percentile. The prevalence of MH in children varies and can reach up to 60%, depending on the study population or the method of BP measurement. Objective. The aim of this study was to determine the prevalence of MH and the role of self-measured blood pressure at home (BPhome) in the diagnosis of MH in children. Materials and methods . In a simple non-interventional study, 149 children (84 boys, 65 girls) aged 10 to 17 years (mean age 14.34±1.91) with BPoff below the 95th percentile were examined. A comparison was made between BPoff, BPhome, and ABPM. Results and discussion . The proportion of patients with stage 1 MH was 28.9%. The prevalence of MH among boys was 29.7%, and among girls, it was 27.7%. According to home self-measurements, 48.3% of patients had systolic BPhome above the 95th percentile, and among them, 54.2% were diagnosed with MH using ABPM. Only 5.2% of patients with normal BPhome were found to have MH based on ABPM. In the MH group, 74.4% of patients were overweight or obese, with boys predominating in the obesity subgroup (84%). Conclusion . The results highlight the important role of self-measured BP at home in children as an indication for ABPM to diagnose MH, despite the lack of standardized procedures and the use of various devices for home BP measurement. The likely phenotype of a patient with MH in pediatric practice is an adolescent boy with obesity and episodes of elevated BP during home self-measurement.