原发性高血压患者微量白蛋白尿与无症状性脑血管损害的研究

目的探讨原发性高血压(EH)患者微量白蛋白尿(MAU)与无症状性脑血管损害及颈动脉粥样硬化的关系。方法根据24h尿蛋白滤过率(UAER)测定结果,将162例EH患者分为正常白蛋白尿(NAU)组101例和MAU组61例。应用高频多普勒超声检测颈动脉内膜中层厚度(IMT)及颈动脉粥样硬化斑块;头颅MRI评价腔隙性脑梗死。采用logistic回归分析颈动脉IMT增厚和腔隙性脑梗死相关的危险因素。结果162例EH患者中MAU的阳性率为37.7%;与NAU组比较,MAU组颈动脉IMT明显增厚[(1.00±0.26)mmvs(0.86±0.20)mm,P<0.01],腔隙性脑梗死的发生率明显增高(62.3%vs44.6%,P<0.05);MAU与颈动脉IMT增厚及腔隙性脑梗死的发生独立相关(OR=2.639,95%CI:1.240～5.615,P<0.05及OR=2.369,95%CI:1.156～4.856,P<0.05)。结论MAU是高血压患者发生腔隙性脑梗死和颈动脉IMT增厚的一个预测指标,可作为判断无症状性脑血管损害及颈动脉粥样硬化的早期指标。     

Relation of left ventricular hypertrophy and geometry to asymptomatic cerebrovascular damage in essential hypertension

Increased left ventricular (LV) mass and abnormal geometry have a powerful prognostic value for cardiovascular morbidity and mortality including stroke. However, there have been no studies on the association between LV hypertrophy and preclinical brain damage in essential hypertensive patients. In the present study, we investigated the relation between LV hypertrophy and asymptomatic cerebrovascular damage identified by magnetic resonance imaging in 150 essential hypertensive patients, with an emphasis on LV geometry. Patients were divided into the following 4 groups according to their LV mass index and relative wall thickness; normal ventricular geometry (n = 50), concentric remodeling (n = 22), eccentric hypertrophy (n = 44), and concentric LV hypertrophy (n = 34). Lacunar lesions and leukoaraiosis were evaluated. The prevalence of lacunae was significantly higher in patients with LV remodeling than in patients with normal LV (chi-square 19.6, p = 0.0002). The number of lacunae was significantly higher in patients with LV hypertrophy than in patients with normal LV or concentric remodeling (F [3,146] = 8.03, p<0.0001). The severity of leukoaraiosis was also significantly greater in patients with LV hypertrophy than in patients with a normal left ventricle (chi-square 14.5, p = 0.02). Stepwise regression analysis confirmed that LV mass index and relative wall thickness, in addition to age and systolic blood pressure, were independent predictors for asymptomatic cerebrovascular damage, even in the absence of neurologic abnormalities. In hypertensive patients, LV hypertrophy, and especially concentric LV hypertrophy, provides important prognostic information on the presence of pre-clinical brain damage.     

Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension

OBJECTIVE: Recent studies have demonstrated a relationship between brain atrophy and hypertension. Systolic hypertension in the elderly has been found to be a risk factor for cognitive impairment. We studied the relationship of ambulatory blood pressure with brain atrophy and cognitive function. METHODS: We performed ambulatory blood pressure monitoring and brain magnetic resonance imaging in 55 unmedicated elderly hypertensive patients (72.7 +/- 6.0 years old). The volume of total brain matter was measured using an intensity contour-mapping algorithm. Cognitive function was assessed by mini-mental state examination score. RESULTS: Total brain matter volume and cognitive function were significantly correlated (r = 0.314, P = 0.02). Total brain matter volume was significantly negatively correlated with age (r = -0.365, P = 0.006), 24-h systolic blood pressure (r = -0.343, P = 0.01), awake systolic blood pressure (r = -0.278, P = 0.04) and sleep systolic blood pressure (r = -0.491, P = 0.0001), and significantly positively correlated with male sex (r = 0.493, P = 0.0001), body mass index (r = 0.282, P = 0.04) and nocturnal systolic blood pressure dipping (r = 0.323, P = 0.02). Mini-mental state examination score was significantly negatively correlated with age (r = -0.277, P = 0.04) and sleep systolic blood pressure (r = -0.360, P = 0.007), and significantly positively correlated with nocturnal systolic blood pressure dipping (r = 0.402, P = 0.002). In multiple linear regression analysis adjusted for age, sex, and body mass index, sleep systolic blood pressure (P = 0.009) was more significantly negatively associated with total brain matter volume than was either 24-h (P = 0.035) or awake (P = 0.020) systolic blood pressure. CONCLUSIONS: In elderly hypertensive patients, absolute ambulatory systolic blood pressure level (particularly during sleep) and nocturnal dipping in systolic blood pressure were strong indicators of brain matter volume and cognitive function.     

动态血压参数与原发性高血压患者靶器官损害的关系

目的探讨24h动态血压参数与原发性高血压患者靶器官损害的关系。方法对140例原发性高血压患者进行24h动态血压监测,根据血压昼夜节律变化消失与否将其分为两组,对两组患者靶器官损害的情况进行对比分析,并对心、脑、肾各靶器官损害的危险因素进行Logistic回顾分析。结果两组脑卒中、左室肥厚、心力衰竭和肾功能损害的发生率差异有统计学意义(P<0.05),24h动态血压参数与各种靶器官损害的相关性不同。结论24h动态血压各参数对高血压患者靶器官损害的影响不同,血压负荷、昼夜血压曲线消失和血压波动幅度与靶器官损害显著相关。     

Exercise blood pressure and target organ damage in essential hypertension

To study whether exercise blood pressure is more closely related to the complications of hypertension than resting blood pressure, 169 patients with essential hypertension, aged 16-66 years, (WHO stages I and II), underwent a graded uninterrupted exercise test on the bicycle ergometer up to exhaustion. BP was measured in intra-arterially. Target organ damage was assessed by eye-fundus grade and by electrocardiographic voltage criteria and T-wave patterns. After adjustment for relevant covariates (age, gender, body height and weight), the manifestations of target organ damage were significantly related to systolic (r ranging from 0.19 to 0.39) and diastolic (r ranging from 0.11 to 0.30) intra-arterial pressure at supine rest. The complications of hypertension were not more closely related to BP during upright submaximal and peak exercise than to resting BP, and exercise BP did not contribute independently from BP at rest to their variance. In conclusion, exercise BP is not better related to target organ damage than BP at rest in patients with essential hypertension.     

Ambulatory blood pressure after acute exercise in older men with essential hypertension

We sought to determine whether reductions in blood pressure in hypertensives after acute exercise persist for more than the 2 to 3 h found in controlled laboratory settings. Subjects (n = 11) were obese (32 ± 4% body fat), sedentary (VO_2max 27 ± 4 mL/kg/min) 60 ± 6-year-old men with stage 1 or 2 essential hypertension. Ambulatory blood pressure was recorded on 1 day preceded by 45 min of 70% VO_2max treadmill exercise and on another day not preceded by exercise. Systolic blood pressure was lower by 6 to 13 mm Hg for the first 16 h after exercise (P < .05) compared to the day without prior exercise. Twenty-four-hour, day, and night average systolic blood pressures were significantly lower on the day after exercise. There was a trend for peak systolic blood pressure to be lower during the entire 24 h and the day portion of the recording; peak systolic blood pressure was significantly lower during the night portion of the recording after exercise. Systolic blood pressure load (percent of systolic blood pressure readings >140 mm Hg) was reduced during the entire 24 h and the day portion of the recording after exercise. Diastolic blood pressure was lower for 12 of the first 16 h after acute exercise (hours 0 to 4, 5 to 8, 13 to 16) (P < .05) compared to the day without prior exercise. Twenty-four-hour, day, and night average diastolic blood pressure was also significantly lower on the recording after exercise. Peak diastolic blood pressure was lower over the entire 24-h period. Diastolic blood pressure load (percent of diastolic blood pressure readings >90 mm Hg) was lower during the entire 24 h and the day portion of the day after exercise. Preliminary data also suggest that common genetic polymorphisms at the angiotensinogen, lipoprotein lipase, and angiotensin converting enzyme loci may affect the blood pressure-lowering response after acute exercise. Thus, in sedentary, obese hypertensive men a single aerobic exercise session reduced blood pressure enough to result in significantly lower 24-h average systolic, diastolic, and mean arterial blood pressure. This could result in a reduced cardiovascular load during the 24 h after acute exercise in older hypertensive men.     

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

The relationship between ambulatory blood pressure (ABP), target organ damage (TOD) and aortic root (AR) size in human hypertension has not been fully explored to date. We investigated the relationship between ABP, different markers of TOD and AR size in never-treated essential hypertensive patients. A total of 519 grade 1 and 2 hypertensive patients (mean age 46+/-12 years) referred for the first time to our outpatient clinic underwent the following procedures: (1) routine examination, (2) 24 h urine collection for microalbuminuria (MA), (3) ambulatory blood pressure monitoring over two 24 h periods within 4 weeks, (4) echocardiography and (5) carotid ultrasonography. AR dilatation was defined by sex-specific criteria (> or =40 mm in men and > or =37 mm in women). AR diameter was increased in 3.7% of patients. Demographic variables (body mass index, age and male gender), average night-time diastolic blood pressure (BP) (but not clinic or average 48 h BP), left ventricular mass index and carotid intima-media (IM) thickness showed an independent association with AR size in both univariate and multivariate analyses. When TOD data were analysed in a categorical way, a stepwise increase in the prevalence of left ventricular hypertrophy (LVH) (I=17.5%, II=27.6%, III=35.8%) and carotid IM thickening (I=20.9%, II=28.8%, III=34.4%), but not in MA (I=6.8%, II=9.1%, III=8.7%) was found with the progression of AR size tertiles. Our results show that (1) AR enlargement in uncomplicated never-treated hypertensive patients has a markedly lower prevalence than traditional markers of cardiac and extracardiac TOD; (2) night-time BP, LVH and carotid IM thickening are independent predictors of AR dimension.     

Ambulatory blood pressure, target organ damage and left atrial size in never-treated essential hypertensive individuals

OBJECTIVE: To investigate the relationship between ambulatory blood pressure and different markers of target organ damage with left atrial size in never-treated essential hypertensive individuals. METHODS: A total of 519 grade 1 and 2 hypertensive patients (mean age 46 +/- 12 years), referred for the first time to our outpatient clinic, underwent routine examinations: 24-h urine collection for microalbuminuria, ambulatory blood pressure monitoring over two 24-h periods in 4 weeks, echocardiography and carotid ultrasonography. RESULTS: Left atrial diameter was increased in 17.3% of patients. No significant differences were found between subjects with and without increased left atrial size with regard to sex, duration of hypertension, clinic and mean 48-h ambulatory blood pressure, and daytime and night-time values. Compared with 429 patients with normal left atrial size, the 90 patients with enlarged left atria were older, had higher body mass index, were more frequently smokers, and included more individuals with the metabolic syndrome. The prevalence of left ventricular hypertrophy, of intima-media thickening, but not of microalbuminuria was significantly higher in subjects with increased left atrial size. CONCLUSION: Left atrial enlargement is not an early echocardiographic finding in relatively young never-treated hypertensive individuals, as its prevalence is lower than that of well-validated markers of target organ damage, and it is unrelated to ambulatory blood pressure. Overweight, left ventricular hypertrophy, carotid intima-media thickening and metabolic syndrome are independent predictors of left atrial dimension, suggesting that changes in left atrial size represent an adaptive response when high blood pressure is associated with other cardiovascular or metabolic abnormalities.     

Ambulatory blood pressure monitoring and organ damage

Several papers have suggested that 24-hour average blood pressure (BP) is superior to office BP in relation to hypertension target organ damage. This review article will specifically address the evidence provided in this regard by either cross-sectional or longitudinal studies. It will also critically discuss the available data supporting the concept that not only 24-hour average BP values, but also specific BP patterns occurring within the 24 hours may have clinical relevance. This is the case for daytime versus nighttime BP, the day/night BP difference, the morning BP rise, and overall BP variability.     

Ambulatory blood pressure in hypertension with dysautonomia

The purpose of the study was to evaluate the interest of ambulatory blood pressure (BP) recording (ABPR) in the management of arterial hypertension (AH) with dysautonomia. The study concerned 8 hypertensive patients (pts), 5 men, 3 females 52 +/- 10 years old, with orthostatic hypotension (OH): BP was 162 +/- 19/87 +/- 16 mmHg and 129 +/- 15/76 +/- 8 mmHg in lying and standing position respectively. In two cases AH was associated with a central degenerative disorder whereas the six other pts had a diabetic dysautonomia: bad metabolic control (HBA1c 14.4 +/- 2.7%), and incipient or over nephropathy (4 pts). ABPR was performed in all pts during 24 hours (space-labs system). In these hypertensive pts with OH, the mean 24 hour-BP was surprisingly normal at 128 +/- 11/76 +/- 6 mmHg. ABPR demonstrated the loss of nocturnal decline in BP: diurnal and nocturnal BP were respectively 125 +/- 13/74 +/- 6 mmHg and 133 +/- 16/78 +/- 10 mmHg (NS). 6 of 8 pts had an increase in BP at night resulting for the population (n = 8) in a nocturnal increase (%) of + 5.6%, this pattern widely differs from controls--13%. The decrease in heart rate during sleep was blunted but significant from 89 +/- 9 b/min to 81 +/- 9 b/min (p 0.01). Diurnal and nocturnal BP variability (V), assessed by variation coefficient were not significantly different: SBP-V was 10.3 +/- 6.4% day and 12.3 +/- 4.2% night, DBP-V 7.5 +/- 6.3% day and 12.5 +/- 3.1% night.(ABSTRACT TRUNCATED AT 250 WORDS)     

继发性高血压24小时动态血压研究

目的研究继发性高血压（ＳＨ）２４小时动态血压变化。方法应用美国Ｓｐａｃｅｌａｂｓ９０２０７动态血压监测仪观察了８０例ＳＨ２４小时动态血压并与年龄、性别相配对的８０例高血压病（ＥＨ）患者进行比较。结果ＳＨ患２４小时血压节律与ＥＨ患者不同,ＳＨ患者夜间血压下降不明显,夜间血压明显高于ＥＨ患者（Ｐ＜００１）;ＳＨ患者夜间血压负荷在６０％左右,而ＥＨ患者夜间血压负荷则在１５％左右;ＳＨ患者与ＥＨ患者２４小时血压曲线：白昼（６：００～２２：００）曲线呈重叠、交叉状态,而夜间（２２：００～６：００）曲线呈分离状态,ＥＨ夜间曲线段明显降低。ＳＨ组非杓型明显多于ＥＴ组（Ｐ＜００１）。ＳＨ患者夜间血压／日间血压的比值大于９０％的例数明显多于ＥＨ患者。结论２４小时动态血压监测显示夜间血压下降不明显,夜间血压负荷在５０％以上,呈非杓型,夜间血压／日间血压的比值大于９０％,提示有ＳＨ可能,应作进一步检查。     

Ambulatory blood pressure measurement, smoking and abnormalities of glucose and lipid metabolism in essential hypertension.

OBJECTIVE: Casual (mercury sphygmomanometer) and ambulatory blood pressure measurements were determined in 61 subjects with sustained essential hypertension. DESIGN: Patients were classified into three subgroups: smokers or non-smokers; patients with or without hyperglycemia; and patients with or without plasma lipoprotein abnormality. Mean casual blood pressure were shown to be identical in these three subgroups. RESULTS: When ambulatory blood pressure was analyzed, smokers exhibited a significant increase in pulse pressure exclusively during the activity period, whereas diastolic blood pressure and mean arterial pressure (MAP) were not modified in comparison with controls. Patients with abnormal plasma glucose showed a significant increase in systolic and pulse pressure during both activity and non-activity periods, with a slight increase in MAP during the activity period. Patients with and without plasma lipid abnormality displayed similar ambulatory blood pressure. CONCLUSION: The study provides evidence that, in spite of similar casual blood pressure levels among smokers and non-smokers, as well as among those with elevated fasting glucose levels, smokers and patients with hyperglycemia have a higher systolic and pulse pressure during 24-h monitoring, pointing to the possible role of cyclic stress in the deterioration in the structure of the hypertensive arterial wall.     

Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension.

OBJECTIVE: To examine the effect of diurnal blood pressure changes upon cerebrovascular damage in elderly patients with hypertension. DESIGN: Fifty-four asymptomatic hypertensive and 34 normotensive elderly subjects underwent both 24-h non-invasive ambulatory blood pressure monitoring and brain magnetic resonance imaging. METHODS. Diurnal variation was defined as a difference of greater than or equal to 10 mmHg between mean awake and asleep systolic blood pressure. Hypertensives were thus classified as dippers or non-dippers. Low intense foci (lacunae) and advanced periventricular hyperintensity were identified as silent cerebrovascular damage. RESULTS: In the hypertensive group, lacunae were correlated more closely with mean asleep systolic blood pressure than with mean awake systolic blood pressure. Age, awake blood pressure, predicted whole blood viscosity, lipid profiles or quantity of sleep did not differ between the hypertensive dippers or non-dippers. The non-dippers, however, showed significantly higher grades of cerebrovascular damage as well as cardiac hypertrophy by electrocardiography than the dippers, whose results were similar to those of normotensives in this regard. CONCLUSIONS: An absent or lower nocturnal blood pressure fall in elderly hypertensives is associated with silent cerebrovascular damage. In contrast, the presence of a nocturnal fall could prevent the development of hypertensive vascular damage.     

Ambulatory blood pressure monitoring and borderline hypertension.

Blood pressure fluctuates during daytime hours in response to changes in activities and to daily life stressors. Lifestyle factors may influence changes in blood pressure through a modulation of the sympathetic nervous system s activity, which is often elevated in subjects with borderline hypertension. In the HARVEST smoking, consumption of coffee, intake of alcohol, physical activity habits, and use of oral contraceptives influenced daytime blood pressure to a greater extent than did office blood pressure and had an effect on sympathetic tone (determined by measuring levels of urinary catecholamines). Subjects with borderline hypertension have a greater than normal risk of cardiovascular morbidity and mortality, but few data on the relation between ambulatory blood pressure and hypertensive complications during the early stage of hypertension are available. In the HARVEST the impact of ambulatory blood pressure on the walls of the left ventricle and on left ventricular mass in women was remarkable, whereas it was weak for men. The assessment of left ventricular systolic function confirmed that ejective performance in many young borderline hypertensive subjects is greater than normal. However, in 9.2% of the HARVEST participants left ventricular contractility evaluated by midwall measurement was found to be depressed. Although the prevalence of microalbuminuria (rate of excretion of urinary albumin > or = 30mg/24h) appeared to be low (6.1%), rate of excretion of albumin was highly statistically significantly correlated to 24h blood pressure. Ambulatory blood pressure monitoring is useful for identifying those borderline hypertensive subjects for whom antihypertensive treatment should be started.     

高血压病合并糖尿病患者的动态脉压监测

目的　探讨高血压病合并糖尿病患者动态脉压 ( APP)监测的临床意义。方法　对 43例健康者 ,64例原发性高血压 ( EH) ,3 0例 EH+DM患者的 APP进行对比研究。结果　 ( 1) EH+DM组 APP≥ 5 0 mm Hg者 ,病例数多 ,年龄偏大 ,左心室肥厚 ( LVH)、心电图异常、心脑血管事件 ( CVD)发生率高 ,与 EH组、对照组相比差异显著 ( P<0 .0 1) ;( 2 ) EH+DM组 APP≥ 5 0 m m Hg组与 <5 0 mm Hg组之间 2 4h平均收缩压 ( SBP)、舒张压 ( DBP)比较无差异 ,但前者其 LVH、心电图异常 ,CVD增高明显 ( P <0 .0 5～0 .0 1) ;( 3 ) 2 4h平均脉压较偶测脉压更能反映病人平时真正脉压水平。结论　 ( 1)高脉压是心脑血管疾病发生和死亡的一个独立和重要的因素 ,其有助于危险分层和指导药物选择 ;( 2 ) APP比偶测脉压更适宜用于临床研究     

原发性高血压患者动态血压和颈动脉斑块与认知功能相关性研究

目的探讨原发性高血压患者动态血压、颈动脉斑块对认知功能的影响。方法将594例高血压患者按24h血压节律及颈动脉斑块的有无分为4组,(1)杓型血压+无颈动脉斑块组(149例);(2)杓型血压+颈动脉斑块组(144例);(3)非杓型血压+无颈动脉斑块组(154例);(4)非杓型血压+颈动脉斑块组(147例)。所有患者进行24h动态血压检测。彩色电脑声像仪逐节段观察颈动脉管壁内膜情况及有无斑块形成。使用简易智能状态检查量表(MMSE)对所有患者进行认知功能调查。结果非杓型血压+颈动脉斑块组、杓型血压+颈动脉斑块组、非杓型血压+无颈动脉斑块组、杓型血压+无颈动脉斑块组MMSE分别为(26.2±1.2)分、(28.3±1.5)分、(28.2±1.5)分(、28.8±0.6)分,非杓型血压+颈动脉斑块组MMSE与其他3组比较,差异有统计学意义(P<0.05,P<0.01)。logMMSE与24 h平均收缩压、昼间平均收缩压、昼间平均脉压、夜间平均收缩压、夜间平均舒张压、夜间平均脉压及颈动脉斑块呈负相关,与收缩压夜间下降率及舒张压夜间下降率呈正相关。结论动态血压节律变化及颈动脉斑块的形成与原发性高血压患者的认知功能损害相关。     

Ambulatory pulse pressure, left ventricular hypertrophy and function in arterial hypertension

BACKGROUND: A wide pulse pressure (PP) can provide important risk assessment information about myocardial infarction, carotid artery atherosclerosis, and global cardiovascular risk. Ambulatory pulse pressure (APP) does not have a well-known prognostic value in hypertensive patients. METHODS:To evaluate the relationship among high APP, atrial volumes, and cardiac function, an observational study was performed on 108 untreated non-elderly hypertensive patients (mean age 54.23 +/- 7.12). Twenty-four-hour ambulatory blood pressure monitoring, Doppler and echocardiographic measurements of systolic, diastolic function, left and right atrial volumes, left ventricular mass index and dimensions, were performed in subjects with both clinic and APP > 60 mmHg (APP1 Group). A control group of hypertensive selected subjects with both clinic and APP < 60 mmHg was chosen (APP 2 Group). RESULTS: The APP1 group showed left atrial volume enlargement, high left ventricular mass index, and impaired diastolic function. A positive correlation was found in the APP1 group results among left ventricular end diastolic diameter (r = 0.39, P < 0.01), left atrial volume (0.38, P < 0.05), and left ventricular mass index (r = 0.33, P < 0.05); clinic PP showed a statistically significant correlation with left atrial volume, left ventricular end diastolic diameter, and left ventricular mass index only in the APP1 group. CONCLUSIONS: These results suggest that elevated APP can be considered an effective predictor of cardiovascular risk in hypertensive subjects. In these patients echocardiographic evaluation of left ventricular function and morphology can increase the prognostic value of PP.     

Circadian rhythm and variability of blood pressure and target organ damage in essential hypertension

The aim of this study was to evaluate the influence of blood pressure variability and circadian rhythm on left ventricular mass and urinary albumin excretion rate (UAE) in patients with essential hypertension. 82 untreated patients (35 women and 47 men; mean age 41.1 +/- 13.7) were recruited to this study. Mean office blood pressure at entry was 152/97 mmHg. Ambulatory blood pressure monitoring (ABPM) was performed using an Medilog ABP recorder (Oxford). Blood pressure variability was estimated as the standard deviation (SD) of systolic and diastolic ambulatory blood pressure. Urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. Echocardiography was used to measure left ventricular mass and left ventricular mass index (LVMI). The median urinary albumin excretion for the whole group was 8.2 mg/day; in 18 patients (21.9%) microalbuminuria was present. Left ventricular mass index in a whole group was 109.1 g/m2; in 23 subjects (28.0%) left ventricular hypertrophy (LVH) was found. Patients with microalbuminuria as well as with left ventricular hypertrophy had higher office and 24 hour ambulatory systolic and diastolic blood pressure and higher systolic blood pressure variability. During ABPM 18 patients with absent nocturnal fall in blood pressure (non-dippers) were found; they did not display more frequent prevalence of target organ damage. Increased 24-hour blood pressure variability present in hypertensive subjects with both microalbuminuria and left ventricular hypertrophy may suggest that this phenomenon plays role in development of target organ damage.     

Ambulatory blood pressure monitoring and target organ damage in pediatrics

The prevalence of hypertension in children and adolescents is rising in association with the increasing rate of childhood obesity, and it is associated with early target organ damage. Published guidelines on high blood pressure in children and adolescents, focused on the early and accurate diagnosis of hypertension, resulted in improved ability to identify children with hypertension. Although auscultation using a mercury sphygmomanometer remains the method of choice for evaluation of hypertension in children, accumulating evidence suggests that ambulatory blood pressure monitoring is a more accurate method for diagnosis, and it is more closely associated with target organ damage. In addition, ambulatory blood pressure monitoring is a valuable tool in the assessment of white-coat hypertension, and masked hypertension in children and adolescents. Masked hypertension in children and adolescents is associated with a similar risk of target organ damage as in established hypertension.