title: Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis.
abstract: OBJECTIVE
  In children, out-of-office blood pressure (BP) assessment (especially ambulatory monitoring) is regarded as indispensable for accurate hypertension diagnosis. This article reviewed the evidence on the association between out-of-office BP measurements and preclinical organ damage indices in children.
  
  
  METHODS
  A systematic review and meta-analysis of 93 relevant articles (1974-2012) was performed.
  
  
  RESULTS
  Analysis of 10 studies (n = 480, pooled age 14.4 years, with hypertension 33%, renal disease 27%, type 1 diabetes 10%) revealed a significant association between systolic ambulatory BP and left ventricular mass index (LVMI), with pooled correlation coefficient r = 0.40 [95% confidence interval (CI) 0.30-0.50]. Eleven studies reported data on LVMI differences between normotensive (n = 428) and hypertensive children (n = 432), with higher values in the latter group by 6.53 g/m(2.7) (95% CI 4.73-8.33). A moderate association was found between systolic ambulatory BP and carotid intima-media thickness (three studies, n = 231, age 13.3 years, pooled r = 0.32, 95% CI 0.21-0.44), as well as between diastolic ambulatory BP and urine albumin excretion (five studies, n = 355, age 13.1 years, type 1 diabetes 42%, reflux nephropathy 28%, pooled r = 0.32, 95% CI 0.05-0.58). Two studies reported on the association between home BP and LVMI, with one of them showing comparable coefficients as for ambulatory monitoring.
  
  
  CONCLUSIONS
  The available evidence suggests a moderate but significant association between ambulatory BP and preclinical organ damage, mainly based on studies in nephropathy and/or diabetes. More data are needed in essential hypertension without nephropathy or diabetes, as well as with home measurements.
authors.affiliation: Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, Sotiria Hospital, University of Athens, Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kollias
authors.forename: Maria
authors.initials: M
authors.lastname: Dafni
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Poulidakis
authors.forename: Angeliki
authors.initials: A
authors.lastname: Ntineri
authors.forename: George S
authors.initials: GS
authors.lastname: Stergiou
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology; D008297:Male