Evaluation of hypertension with 24 hour blood pressure monitoring in obese children

EVALUATION OF HYPERTENSION WITH 24 HOUR BLOOD PRESSURE MONITORING IN OBESE CHILDRENHypertension incidence in childhood is % 1-5. Hypertension (HT) is classified as primary and secondary and most common etiology in childhood is secondary hypertension due to renal pathologies. But recently with increase in prevalence of obesity, an important risk factor for HT, primary HT incidence has rised. For prevention of complications of HT early diagnosis and treatment is important, for this reason importance of HT screening in obese patients is especially emphasized.24 Hour Ambulatory Blood Pressure Monitoring (ABPM) is especially considered to be important in defining HT. With this method ? white coat hypertension? is prevented by making measurements outside of health care facility. Also another important point is with this method we have the opportunity to evaluate 24 hour circadian rythm changes in blood pressure.İn guidance of these informations blood pressure changes in obese children and normal weight children was comparatively evaluated with ABPM in our study. At the same time in addition to hypertension, insulin resistance and dyslipidemia, both of which is important risk factor obesity and have effect on HT, were also evaluated.38 obese children between ages of 7-17 years and 30 normal weight children as control group were included in the study. All of the children were screened by ABPM. At the same time insulin resistance is evaluated with 2 methods (HOMA-IR and glucose insulin ratio) and lipid levels are determined for dyslipidemia.When ABPM results were evaluated in obese children, findings related to isolated systolic HT, first symptom of obesity related HT, were obtained.İn obese children blood pressure burden was determined at levels close to the levels causing target organ damage, this in turn shows that ABPM may give us the opportunity to detect patients at risk of complications in addition to screening of HT.An other important finding is nocturnal decrease in blood pressure (nocturnal dip). It is reported that in obese children it doesn?t occur, but in our study significant difference between two groups wasn?t found. This could be due to decrease in sleep quality due to ABPM.İn obese children, another important finding other than systolic HT, is significant relationship between ABPM with BMI percentile and BMI SDS increase in normal children. This finding emphasizes the need for follow up of HT in normal weight or overweight children gaining weight.Insulin resistance plays important role in pathogenesis of obesity related HT, at the same time it is a component of metabolic syndrome. Between two groups in our study there was not any significant difference. One of the reasons for this finding may be appearence of insulin resistance in control group patients who are not obese or not in the limit of being overweight but having BMI percentile and BMI SDS values close to the values of obese and overweight children. When two methods are evaluated according to specifity and sensitivity, findings indicating glucose insulin ratio as the better one to use was found. This finding was contrary to the literature.The other risk factor, dyslipidemia, was found more in obese children.It is observed that obesity, insulin resistance and dylipidemia have similar effects on HT or ABPM parameters and neither of them are superior to each other. İmportance of evaluation HT in obese children should not be forgotten. Effects of risk factors, other than obesity, on HT are similar so while diagnosis of HT is being made obesity, insulin resistance and dyslipidemia should be evaluated together.Key Words: Hypertension, obesity, ambulatory blood pressure monitoring, insulin resistance, dyslipidemia