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. It has not yet been clear whether intradialytic hypertension (IDHN) translates into the presence of high BP between dialysis sessions or not. In this study, we aimed to perform interdialytic AMBULATORY BLOOD PRESSURE MONITORING (ABPM) in patients with IDHN to find whether high BP persists at home. Methods. In this case-control study, ABPM was performed during a 44-hours interdialytic period in patients on maintenance hemodialysis (HD) with pre-dialysis systolic BP (SBP) above 130 mmHg. Bland-Altman graphs were used to investigate the magnitude of the difference between the results of ABPM records and intradialytic BP measurements in patients with and without IDHN. Results. A total of 56 patients were enrolled in our study (29 in the IDHN group and 27 in the control group). The average of the pre-dialysis SBP in 6 consecutive HD treatments was 146. 6 ± 11. 36 vs. 146. 8 ± 12. 1 mmHg in IDHN and control group, respectively (P >. 05). Mean post-dialysis SBP was 154. 45 ± 12. 6 mmHg in the IDHN group and 136. 76 ± 11. 50 in the control group (P <. 001). Mean ± SD of 44-hour SBP was 157. 31 ± 20. 27 mmHg in the IDHN group, which was significantly higher than that in the control group (146. 5 ± 16. 67 mmHg, P <. 05). No significant differences were seen in the average of interdialytic weights gain between the two groups. Compared to the pre-dialysis SBP, using Bland-Altman graphs, the post-dialysis SBP (bias of 3. 5 mmHg) had closer readings to the daytime SBP in the IDHN group. Conclusion. Patients with IDHN had higher interdialytic BPs. Among BPs taken during HD in patients with IDHN, post-dialysis SBP had the lowest difference with the daytime SBP taken by ABPM.

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.

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.

Background: Maternal hypertensive disorder is a well-known medical problem during pregnancy and is associated with morbidity and mortality. Out-of-office BLOOD PRESSURE (BP) measurement has been widely used but the importance of detecting white coat hypertension (WCH) is still a topic for debate. Objectives: The aim of this study was to determine the prevalence of WCH in high-risk pregnant women. Methods: We included 56 pregnant women with in-office higher-than-normal BP without previous history of HTN to assess their BP using 24-hour AMBULATORY BLOOD PRESSURE MONITORING (ABPM). Results: The mean age of the participants was 31. 61 5. 42 years (n = 56) and the majority in the second or third trimesters. Hypertension was detected in 55. 4% using 24-hour ABPM. Twenty-five patients (44. 6%) had WCH, 60% of whom were in the third trimester. There was a significant difference in the incidence of WCH between women younger than 30 and older individuals (P = 0. 041). The mean age was 33. 13 5. 16 years in patients with true HTN and 29. 72 5. 22 years in WCH patients (P = 0. 018). Conclusions: The prevalence of WCH in pregnancy is noteworthy. Regarding its favorable outcome, this might be a heads-up to avoid unnecessary medication during pregnancy and be concise about defining HTN in this population.

Introduction: Hypertension is one of the most common human disease and a major risk factor for cardiovascular disease. Angiotensin converting enzyme inhibitor (ACE!) drugs, including captopril, is used for treatment of hypertension frequently. In this study BLOOD PRESSURE control parameters of captopril was compared between Iranian and foreign types by 24-hours AMBULATORY BLOOD PRESSURE MONITORING.Methods: Onehundred and twenty five patients with mild to moderate primary hypertension were included in a randomized double blind clinical trial. After a wash out period, patients performed a 24-hours AMBULATORY BLOOD PRESSURE MONITORING, and then treated by one of the three Iranian-types (Iran Dam, Lorestan and Dam Paksh), foreign type captopril and placebo randomly. After Four weeks treatment, BLOOD PRESSURE MONITORING was performed again. Statistical analysis was done with ANOVA and T-Student test.Results: The study showed that all types of these drugs reduced BLOOD PRESSURE significantly related to placebo (P<0.05). No significant difference was detected in magnitude, duration and maximum effect between them (Except for non-statistically significant longer effect in foreign type). In foreign type, time to reaching maximum effect was shorter significantly than Iranian types.Discussion: This study showed that all types of Iranian captopril have similar anti-hypertensive quality, and according to no greater effect in foreign type, so it's not logical to use it because of greater cost to patient and community.