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Abstract: TH-PO696

Obesity and Older Age Are Associated with Uncontrolled Hypertension in Children with Kidney Transplant in the Improving Renal Outcomes Collaborative (IROC)

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Winterberg, Pamela D., Emory University School of Medicine, Atlanta, Georgia, United States
  • Garro, Rouba, Emory University School of Medicine, Atlanta, Georgia, United States
  • Kelleman, Mike, Emory University School of Medicine, Atlanta, Georgia, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Goebel, Jens W., Children's Hospital Colorado, Aurora, Colorado, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, United States
Background

Hypertension (HTN) is common in children following kidney transplant (KT) and uncontrolled blood pressure (BP) is associated with long-term outcomes. This study determined risk factors for HTN diagnosis and BP control using registry data from the Improving Renal Outcomes Collaborative (IROC), after standardizing appropriate BP measurement

Methods

We examined the latest clinic visit for each patient >90 days post-KT in the IROC registry that had documented appropriate BP measurement and complete medication data. Appropriate BP measurement was defined as either normal oscillometric measurement (2004 NHBPEP 4th Report), or combined documentation of 5 minutes of rest, use of upper extremity, and appropriate cuff size on a manual measurement. Appropriate BP measurements were next classified using the staging definitions in the 4th Report, which were still in use by IROC for determining BP control in clinic. HTN diagnosis was defined by either active HTN medication or BP ≥ Stage 1. BP control was defined as normal BP stage (BP <90th percentile and <120/80 mmHg) for those with HTN. Overweight was defined as BMI ≥85 %tile or 35 kg/m2. Clinicodemographic factors associated with HTN diagnosis and BP control were assessed with Chi-square tests, odds ratios (OR), and 95% confidence intervals.

Results

A total of 773 patients from 17 centers were included in the study. Of these, 469 (61%) met criteria for HTN diagnosis. HTN diagnosis was more frequent in patients that were overweight (73% vs 27%, p=0.003), ≥18 years old (72% vs 56%, p<.001), of African American descent (69% vs 59%, p=0.02), or on calcineurin inhibitors (p=0.002). Of those with HTN, 240 (51%) were well-controlled and 32% had BP ≥ Stage 1. Overweight patients (OR 1.71, CI 1.18-2.50) and those ≥18yo (OR 1.79, CI 1.21-2.64) were more likely to have uncontrolled BP. Overweight individuals also had more severe uncontrolled HTN (39% ≥ Stage 1) than normal weight individuals (27%, p=0.01).

Conclusion

Uncontrolled HTN is common in children with KT. Obesity was identified as a significant modifiable risk factor for both HTN diagnosis and BP control. Additional research is needed to identify factors contributing to higher rates of uncontrolled BP in pediatric kidney transplant recipients in early adulthood.

Funding

  • NIDDK Support