Masked hypertension: A new concept for pediatricians

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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.