White coat hypertension in children with elevated casual blood pressure

Objective: We reviewed our experience using ambulatory blood pressure monitoring (ABPM) in children rcferred to a hypertension clinic to determine the frequency of pediatric white coat hypertension (WCH). Study design: WCH was defined by 3 different diagnostic criteria: (1) mean 24-hour blood pressure (BP) less than Task For ce-defined 95th percentile, (2) mean 24-hour BP less than 95th percentile from pediatric normative ABPM data, and (3) mean 24-hour BP less than ABPM 95th per-centile and BP load (percentage of BP readings during 24-hour period exceeding the 95th percentile) less than 25%. Results: Clinic BP values were available in 67 otherwise healthy children who underwent ABPM; 51 had confirmed clinic hypertension by Task For ce criteria. WCH frequency in these 51 patients with the stated criteria was 53%, 45%, and 22%, respectively. Elevated BP load was found in 52% (12/23) of patients with normal mean BP. Conclusion: Those results suggest that many children referred fbr casual BP elevation have WCH even by strict diagnostic criteria. ABPM may help differentiate WCH fr om persistent hypertension, thereby avoiding unnecessary diagnostic evaluation and identifying children most likely to benefit from early intervention.