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Masked hypertension: A new concept for pediatricians
This Month in
THE JOURNAL OF
PEDIATRICS April 2008 • Volume 152 • Number 4 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Eating more fruits and vegetables: A new approach
Masked hypertension: A new concept for pediatricians
In general, children consume fewer than the recommended servings of fruits and vegetables on a daily basis. Children who are at risk for obesity, hypertension, or elevated cholesterol tend to consume even fewer servings of fruits and vegetables than their peers. It is very difficult to successfully encourage an increased consumption of fruits and vegetables in children who are at risk. The article by Couch et al explores a different strategy for increasing the consumption of fruits and vegetables. They use the Dietary Approaches to Stop Hypertension (DASH)-type diet in the treatment of children with elevated blood pressure. The treatment group did demonstrate lowering of their blood pressure following the use of the DASH-type diet. A side effect of the DASH diet, however, was an increased consumption of fruits and vegetables when compared with a control group that received routine outpatient hospital-based nutritional care. If this can be duplicated in larger studies, it is an additional treatment modality that not only will lower high blood pressure but will also increase the consumption of fruits and vegetables in children with obesity, hypertension, and/or elevated cholesterol.
For decades pediatricians have been concerned about blood pressure elevation identified during the course of clinical care. It has become increasingly clear that blood pressure elevation in children is important and can have both short- and long-term consequences. Pediatricians have also learned that elevated blood pressure may not always be as important as it first appears because some children will have white coat hypertension, with blood pressure elevation in the office or hospital setting but not on 24-hour monitoring. In this issue of The Journal, Maggio et al raise a new concern: masked hypertension. This occurs when blood pressure is normal in the clinic setting, but is elevated in a 24-hour blood pressure monitor test. Masked hypertension has been recognized in adults but has received far less attention in children. In their study, Maggio et al found that casual blood pressure missed hypertension that was present in a 24-hour monitor test 55% of the time. The prevalence of masked hypertension was 26.2% in their study population. In an editorial, Urbina emphasizes the need to better understand how to identify pediatric patients with masked hypertension and also better understand the level of risk these patients have for future cardiovascular disease. It is likely that future research will address these issues and clarify how pediatricians should approach the potential for masked hypertension in the clinical setting.
—Reginald L. Washington, MD page 494
—Stephen R. Daniels, MD, PhD page 489 (article) page 455 (editorial)
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
April 2008
A1
THE JOURNAL OF
PEDIATRICS April 2008 • Volume 152 • Number 4 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Eating more fruits and vegetables: A new approach
Masked hypertension: A new concept for pediatricians
In general, children consume fewer than the recommended servings of fruits and vegetables on a daily basis. Children who are at risk for obesity, hypertension, or elevated cholesterol tend to consume even fewer servings of fruits and vegetables than their peers. It is very difficult to successfully encourage an increased consumption of fruits and vegetables in children who are at risk. The article by Couch et al explores a different strategy for increasing the consumption of fruits and vegetables. They use the Dietary Approaches to Stop Hypertension (DASH)-type diet in the treatment of children with elevated blood pressure. The treatment group did demonstrate lowering of their blood pressure following the use of the DASH-type diet. A side effect of the DASH diet, however, was an increased consumption of fruits and vegetables when compared with a control group that received routine outpatient hospital-based nutritional care. If this can be duplicated in larger studies, it is an additional treatment modality that not only will lower high blood pressure but will also increase the consumption of fruits and vegetables in children with obesity, hypertension, and/or elevated cholesterol.
For decades pediatricians have been concerned about blood pressure elevation identified during the course of clinical care. It has become increasingly clear that blood pressure elevation in children is important and can have both short- and long-term consequences. Pediatricians have also learned that elevated blood pressure may not always be as important as it first appears because some children will have white coat hypertension, with blood pressure elevation in the office or hospital setting but not on 24-hour monitoring. In this issue of The Journal, Maggio et al raise a new concern: masked hypertension. This occurs when blood pressure is normal in the clinic setting, but is elevated in a 24-hour blood pressure monitor test. Masked hypertension has been recognized in adults but has received far less attention in children. In their study, Maggio et al found that casual blood pressure missed hypertension that was present in a 24-hour monitor test 55% of the time. The prevalence of masked hypertension was 26.2% in their study population. In an editorial, Urbina emphasizes the need to better understand how to identify pediatric patients with masked hypertension and also better understand the level of risk these patients have for future cardiovascular disease. It is likely that future research will address these issues and clarify how pediatricians should approach the potential for masked hypertension in the clinical setting.
—Reginald L. Washington, MD page 494
—Stephen R. Daniels, MD, PhD page 489 (article) page 455 (editorial)
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
April 2008
A1