White coat hypertension and left ventricle geometry in childhood.

Abstract

Purpose: It is not clear whether white-coat hypertension (WCH) is related to the development of left ventricular geometry changes in children.

Materials and methods: This retrospective, single-centre study categorised patients into obese and normal-weight groups. The obese cohort comprised 72 with hypertension (48 male, 12.3 ± 3.2 years), 40 with white-coat hypertension (WCH; 29 male, 12.9 ± 2.8 years) and 31 normotensive controls (18 male, 11.9 ± 2.2 years). The normal-weight cohort included 62 with hypertension (40 male, 12.9 ± 3.9 years), 32 with WCH (21 male, 12.5 ± 3.3 years) and 89 normotensive controls (60 male, 13.0 ± 2.1 years). Echocardiography and ambulatory blood pressure monitoring were performed for all participants with WCH or hypertension. Abnormal left ventricular geometry was defined as the presence of concentric remodelling, concentric left ventricular hypertrophy (LVH), or eccentric LVH.

Results: The prevalence of abnormal left ventricular geometry demonstrated a significant, stepwise increase from the control group to the WCH and hypertension groups among normal-weight children (1%, 9.4% and 25.8%, respectively; p < .001). This graded trend was absent in children with obesity, where the prevalence was elevated across all groups but did not increase progressively with the severity of the blood pressure phenotype (19.3%, 15% and 45.8%, respectively; p = .002).

Conclusion: These findings suggest that WCH may signify an intermediate cardiovascular risk state even in the absence of obesity. From a preventive medicine perspective, the identification of WCH in normal-weight children warrants periodic blood pressure monitoring. While our study clearly establishes the presence of this association in normal-weight youth, the specific nature of the interaction between WCH and obesity - whether additive or synergistic - warrants further investigation in larger, longitudinal cohorts.