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Abstract: PO2082

Non-Dipping and Left Ventricular Hypertrophy Among Adolescents with White Coat Hypertension

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Shah, Paras P., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Merchant, Kumail, Cohen Children's Medical Center, Queens, New York, United States
  • Singer, Pamela, Cohen Children's Medical Center, Queens, New York, United States
  • Castellanos, Laura J., Cohen Children's Medical Center, Queens, New York, United States
  • Sethna, Christine B., Cohen Children's Medical Center, Queens, New York, United States
Background

Recent literature suggests that white-coat hypertension (WCH) may not be a benign phenomenon. In adults, WCH has been associated with increased cardiovascular disease (CVD) risk. Additionally, non-dipping has been independently linked to left ventricular hypertrophy (LVH) and CVD. However, the prevalence and prognostic impact of non-dipping in WCH in the pediatric population remains unclear. The objective was to determine the prevalence of non-dipping in adolescents with WCH and to examine the association of dipper status with left ventricular mass index (LVMI) and LVH.

Methods

Ambulatory blood pressure monitoring (ABPM) and echocardiogram (ECHO) reports from adolescents age 13-21 years performed from 2015-2019 at a single center were analyzed. WCH was defined as office blood pressure (BP) >95th%tile and mean ABPM <95th%tile (AHA 2014). Those with hypertension or pre-hypertension were excluded. Non-dipper status was defined as <10% drop in nocturnal BP. Non-dippers with an increase in nocturnal BP were classified as reverse dippers. T test and chi-square were used to compare LVMI and LVH (defined by LVMI >95th%ile reference values and LVMI >51g/m2.7) by dipper status. Linear/logistic regression adjusted for age, sex and body mass index (BMI) z-score were used to determine the association of non-dipping with LVMI and LVH.

Results

Of 49 adolescents (15.7±1.7 years, 84% male), 17 (34.7%) were identified as non-dippers. Of the non-dippers, 4 (23.5%) exhibited reverse dipping. Of those with LVMI >95th%ile, 3 (33.3%) were non-dippers and 3 (23.1%) were dippers (p=0.68), and the only individual (11.1%) with LVMI >51g/m2.7, was a non-dipper (p=0.24). There was no significant difference in LVMI between dippers and non-dippers (35.9±8.8 vs. 34.2±6.8 g/m2, p=0.63). There were no significant associations between dipper status (reference dipper) and LVMI (β 0.67, CI: -7.92-9.26, p=0.87) or LVH by LVMI >95th%ile (OR 0.72, CI: 0.08-6.74, p=0.78) in adjusted regression models.

Conclusion

Although non-dipping is not associated with LVMI or LVH in adolescents with WCH, the fair prevalence (34.7%) of non-dipping among this population is of note. Given adult studies demonstrating the progression of non-dipping to poor CVD outcomes, these potentially high-risk patients should be monitored closely.