Objectives To identify masked hypertension amongst adolescents presenting to Paediatrics OPD with physical symptoms of stress using ambulatory blood pressure monitoring. To find the correlation of various parameters of Hypertension (Masked Hypertension, Nocturnal Hypertension, Elevated Blood Pressure) with different domains of stress amongst adolescents using adolescent stress questionnaire.
Methods Adolescents (13–18 years of age) presenting to Paediatrics OPD of AIIMS Jodhpur with somatic symptoms attributable to stress were prospectively enrolled from January 2019 to March 2020. Ambulatory blood pressure monitoring was performed on those meeting inclusion criteria to identify masked hypertension and various BP phenotypes followed by administration of a self instructed Adolescent Stress Questionnaire.
Results Seventy adolescents aged 15.78 ± 1.12 years were evaluated. There was female (1.7:1) preponderance with headache (62.9%) and pain abdomen (27.1%) being the most common identifying symptoms. The prevalence of masked hypertension, white coat hypertension and elevated BP was 12.8%, 5.7%, and 4.2% respectively as depicted in Image 1. 55.55% of these hypertensive subjects were also identified to have an abnormal nocturnal dipping pattern.
The stress of future uncertainty was the most prevalent followed by stress of school performance and school attendance. Those with elevated blood pressure had higher stress of peer pressure stress, interaction with teachers, school performance and overall stress of emerging responsibility as an adult as described in table 1. There was no significant association identified between sex, age, duration, or number of symptoms with the 10 domains of the Adolescent stress questionnaire, and hypertension among adolescents.
Conclusions Adolescents visiting health care centers with non-specific complaints might have masked hypertension and such population is at increased risk of developing hypertension in the future. ABPM may unmask various forms of hypertension amongst adolescents with somatic symptoms of stress. Early lifestyle modification and proper counseling can modify the risk of progression to sustained hypertension. The stress of future uncertainty seems to be perceived as a common cause of distress among mid-adolescence.
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