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Abstract: FR-PO1068

Recategorization of Adolescent Hypertension (HTN) by Ambulatory Blood Pressure (ABPM) Using Adult Norms Compared with Pediatric Norms

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Campbell, Fallon, Texas Children's Hospital, Houston, Texas, United States
  • Shah, Shweta S., Texas Children's Hospital, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States
  • Acosta, Alisa A., Texas Children's Hospital, Houston, Texas, United States
Background

2017 guidelines for pediatric blood pressure (BP) applied adult BP norms to define clinic HTN in patients (pts) ≥ 13 yrs. The 2014 pediatric ABPM guidelines recommend age and sex specific percentile norms for pts < 18 yrs. Data applying adult ABPM norms to define ABPM HTN in adolescents is scarce. We aimed to evaluate the re-categorization of HTN by ABPM alone when applying adult ABPM norms in pts ≥ 13 yrs. We then assessed the association of left ventricular hypertrophy (LVH) with HTN.

Methods

Retrospectively, pts 13-17 yrs who wore an ABPM between 9/2018 and 5/2019 were reviewed to collect gender, age, BP med status, ABPM systolic and diastolic BP mean and load for 24hr, day, and night, and left ventricular mass index (LVMI). The ABPM adult norms applied were based on American Heart Association (AHA) 2005 (AHA2005), AHA 2017 (AHA2017), and European Society of Hypertension 2018 (ESH) guidelines and were compared to 2014 AHA pediatric norms (pABPM). HTN was defined according to the respective guidelines using only ABPM. LVH was defined as LVMI > 51 g/m2.7.

Results

357 pts (243 male) had ABPM data. 172 had LVMI data; 33 pts on BP meds with controlled HTN were excluded (final n=139). LVMI correlated significantly with systolic BP (24h, day, night mean and load) but not diastolic BP. All adult norms resulted in significant differences in the re-categorization of HTN (Table). The odds of a pt with HTN having LVH was significant only when defined by AHA2005 and ESH norms [OR 3.86 (1.55, 9.61), p=0.004 and OR 2.63 (1.05, 6.57), p=0.04 respectively].

Conclusion

There is significant difference in the categorization of HTN depending on the norms applied. HTN is significantly associated with LVH when AHA2005 and ESH norms are applied. Application of adult norms to define ABPM HTN in adolescents should take into account these differences with thoughtful evaluation of outcomes.

Categorization of HTN by adult norms (%)
  AHA2005AHA2017ESH
  no HTNHTNno HTNHTNno HTNHTN
pABPMno HTN4423115433
HTN35197472035
p by X2 <0.001<0.001<0.001