Pediatric hypertension (HTN) is a growing concern and should be diagnosed and treated aggressively to reduce the global disease burden. Ambulatory blood pressure monitoring (ABPM) is a useful clinical tool providing a more accurate description of the patient's blood pressure (BP) than office BP measurements, and can be considered the "gold standard" in the evaluation of the pediatric patient with a concern for HTN. Routine use of ABPM is recommended among clinicians to better evaluate and assess the severity of a child's HTN, and for proper management in order to prevent target organ damage and the resulting sequelae, thereby reducing the burden of cardiovascular risk in hypertensive children and adolescents. Significant data exist that link elevated BP levels measured in childhood and future target-organ damage. Untreated hypertensive children had lower cerebral artery reactivity than normotensive control subjects, which may explain the lower scores on cognitive tests found in children with elevated BP. Indications for routine performance of ABPM: To confirm the diagnosis of hypertension (R/O WCH), To evaluate for the presence of masked HTN, To assess BP patterns in high-risk patients, To evaluate effectiveness of drug therapy for HTN. Expert opinion in pediatric ABPM recommends that at least 1 or 2 valid readings should be obtained per hour over the entire 24 hours. Interpretation of ABPM studies is usually based on a combination of criteria, including mean SBP or DBP and BP loads. BP load is then calculated as the proportion of readings above a threshold (usually the pediatric 95th percentile).

INTRODUCTION: The study was conducted to define the determinants of suboptimal blood pressure (BP) control among hypertensive patients under treatment and explore a predictive model for detecting the patients at risk for increased BP.METHODS: We enrolled 97 patients (40 males, 57 females) under treatment for hypertension between June 2006 and May 2007 in Shafa hospital, Kerman, Iran. BP was measured at clinic twice within 5-minute intervals. After setting up ambulatory blood pressure monitoring (ABPM), BP was measured at 30-minute intervals during the day and 60-minute intervals during the night. The frequency of increased BP (more than 140/90 mmHg) was included in a regression model as dependent variable and all the others such as age, sex, body mass index (BMI), drugs and baseline clinical measurements as the predictors.RESULTS: Increased BP was detected in 44% (95% CI: 38.79%-49.65%) of all measurements during 24-hour monitoring. The frequency of increased BP had a significant relationship with BMI (β=0.35, P=0.001). Clinic's pulse pressure was a significant predicting factor for BP increase (P=0.02).CONCLUSION: BMI and pulse pressure are the best predictors for being hypertensive during lifetime. Ineffective treatment of hypertension is frequent among the hypertensive patients.

Introduction. Ambulatory blood pressure monitoring (ABPM) is a valuable tool for detecting abnormalities in nighttime blood pressure (BP), including non-dipping and nighttime hypertension. These abnormalities are independent predictors of a poor prognosis in patients with chronic kidney disease (CKD). The aim of our study was to analyze ABPM data and evaluate nighttime BP abnormalities in an Iranian CKD population. Methods. This cross-sectional study was conducted on sixty two patients at stages III and IV of CKD who were referred to a nephrology clinic in Tehran, Iran. The patients were classified as either dippers (19. 4%) or non-dippers (80. 6%), as well as nighttime normotensives (38. 7%) or hypertensives (61. 3%), based on ABPM data and in accordance with 2023 ESC/ESH guidelines. We compared demographic data, estimated glomerular filtration rate (eGFR), and daytime BP levels among these groups. Results. The mean age of patients was 56. 34 years, with 61. 1% of them being male. Daytime pulse pressure was significantly greater in non-dippers compared to dippers (52. 67 vs. 44 mmHg, P =. 02). We found a significant correlation between the extent of BP dipping and eGFR (R = 0. 281, P =. 02). Systolic and diastolic daytime BP levels were significantly higher in individuals with nighttime hypertension. Diabetic patients were more likely to be non-dippers and have nighttime hypertension. After adjusting for age, diabetes mellitus, and daytime pulse pressure in a multivariable model, we determined that eGFR independently predicted the extent of BP dipping. Conclusion. Our results showed that both non-dipping and nighttime hypertension are highly prevalent in CKD patients, but they have distinct contributing factors. The eGFR was identified as an independent predictor of BP dipping, whereas nighttime BP levels were primarily determined by daytime BP levels.