Children and adolescents with classical congenital adrenal hyperplasia have been shown to be at risk for obesity associated with higher insulin and leptin levels. Since these factors are also known to cause hypertension the aim of this study was to analyze 24-hour blood pressure profiles and their relation to different clinical and laboratory parameters.

Design: 55 subjects, aged between 5.3 and 19.0 yr were enrolled in a prospective, cross-sectional study. All patients had genetically proven 21-hydroxylase deficiency and underwent ambulatory 24-hour blood pressure monitoring during a period off school/work (Mobil-O-Graph^TM, I.E.M., Solberg, Germany).

Results (median, range): The median body mass index of the cohort was significantly elevated (1.09 SDS, -2.45 to 3.77). Daytime and night-time systolic blood pressures were also significantly elevated (0.67 SDS, -1.5 to 4.1; 0.63 SDS, -0.91 to 3.3), while daytime diastolic blood pressure was significantly lowered (-0.81 SDS, -2.6 to 3.2) and normal during the night (0.11 SDS, -2.0 to 2.0). Overall, there was a normal nocturnal drop of systolic (12.8%, 2.1 to 22.8) but not of diastolic blood pressure (17.2%, 0.90 to 25.8). The different parameters of systolic and diastolic blood pressures were significantly correlated with body mass index and skinfold thickness (r_s=0.271 to 0.486). There was no correlation with equivalent hydrocortisone and fludrocortisone dosage, and laboratory parameters except for serum leptin and insulin.

Conclusions: Our data show altered 24-hour blood pressure profiles with elevated systolic levels correlated with the degree of overweight and obesity, whereas normal-weight patients tended to diastolic hypotension.