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Kidney Week

Abstract: FR-PO1064

Discordances Between Pediatric and Adult Thresholds in the Diagnosis of Ambulatory Hypertension in Adolescents with CKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Lee, Jason T., University of California San Francisco, San Francisco, California, United States
  • Black, Elizabeth Ashley, University of California San Francisco, San Francisco, California, United States
  • Seth, Divya, University of California San Francisco, San Francisco, California, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Samuels, Joshua A., University of Texas, Houston, Texas, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

The diagnostic threshold for hypertension (HTN) by 24-hour ambulatory blood pressure (ABP) monitoring in adults was changed in the updated American Heart Association (AHA) 2017 guidelines. Our objective was to compare the prevalence, sensitivity/specificity, and predictive value of a diagnosis of HTN by pediatric versus adult ambulatory thresholds in children with CKD.

Methods

We included 371 children with CKD ages 13 or older. We used normative pediatric cutoffs (sex/height-based), prior adult cutoffs (awake SBP>135 mmHg, sleep>120), and updated AHA 2017 cutoffs (awake>130mmHg, sleep>110) to define HTN and determine its prevalence. We then compared the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of each threshold for development of left ventricular hypertrophy (LVH) and progression to end-stage renal disease (ESRD).

Results

27% of the cohort met criteria for HTN using pediatric ABP normative thresholds, versus 44% by the updated AHA 2017 adult threshold and 16% by prior adult guidelines (Table). For LVH, the sensitivity of all thresholds was poor with the prior adult criteria being the least sensitive but most specific (Figure). For ESRD, the updated AHA 2017 adult threshold had the greatest sensitivity but lowest specificity (Figure). Overall, the PPV and NPV were similar across all thresholds for LVH and ESRD.

Conclusion

In adolescents with CKD, the updated AHA 2017 adult threshold leads to the highest prevalence of ambulatory HTN and has variable sensitivity and specificity for LVH versus ESRD. The pediatric thresholds had lower sensitivity but higher specificity vs. the AHA 2017 criteria. Further research is needed to optimally define ambulatory HTN as adolescents transition to adulthood.

Funding

  • NIDDK Support