LAUSR

Objective: To evaluate the relationship between nighttime blood pressure (BP) assessed by home (HBP) or ambulatory (ABP) monitoring with target-organ damage in children and adolescents. Design and method: Apparently healthy children and adolescents (age 6–18 yeas) referred for elevated BP were subjected to (i) 24-hour ABP monitoring using a validated upper-arm cuff oscillometric device (Microlife WatchBP O3), (ii) HBP monitoring during daytime (7 days, duplicate morning and evening measurements) and nighttime (automated measurements, 3 nights, 3 hourly measurements/night) using a validated upper-arm cuff oscillometric device (Microlife WatchBP HOME N), (iii) carotid intima-media thickness (cIMT) measurement (high resolution B-mode ultrasonography) at the level of common carotid and bulb bilaterally using automated software, (iv) carotid-femoral pulse wave velocity (PWV; Complior device; duplicate measurements), and (v) echocardiographic determination of left ventricular mass index (LVMI). Results: 27 individuals were included (mean age 12.4 ± 3.2 years, 16 males, body mass index [BMI] 24.4 ± 5 kg/m2, 6 with office hypertension [BP >  = 95th percentile] and 4 with high-normal office BP [> = 90th to < 95th percentile]). Nighttime HBP monitoring was feasible in all subjects (average number of HBP monitoring nights 2.7 ± 0.7 and nocturnal HBP readings 7.6 ± 2.2). Daytime HBP and ABP values were similar (difference −0.3 ± 5.3/1.5 ± 5.2 mmHg, systolic/diastolic, p = NS), whereas nighttime HBP was slightly higher than the respective ABP value (2.9 ± 7.2/2.4 ± 6.6 mmHg, p < 0.05/NS respectively). There was a strong association between daytime ABP and HBP (r = 0.83/0.61, systolic/diastolic), as well as between nighttime values (r = 0.73/0.42) (all p < 0.05). Both nighttime systolic ABP and HBP were associated with all indices of target-organ damage (LVMI: r = 0.39 versus 0.20 respectively; cIMT: 0.47 versus 0.46; PWV: 0.26 versus 0.39; p = NS for comparisons of coefficients). Participants reported a higher score for inconvenience (questionnaire) with nighttime ABP than HBP (1.4 ± 0.8 versus 1.1 ± 0.7 respectively, p < 0.05) and 77% preferred nighttime HBP versus ABP. Conclusions: These preliminary results suggest that in children and adolescents nocturnal HBP monitoring is feasible and preferred by users than nocturnal ABP, and similarly associated with preclinical target-organ.