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Abstract: PO2323

Is a Single Static Cut Point Useful to Define Ambulatory Hypertension in Youth? The SHIP AHOY Study

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Hamdani, Gilad, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
  • Ferguson, Michael A., Boston Children's Hospital, Boston, Massachusetts, United States
  • Lande, Marc, University of Rochester Medical Center, Rochester, New York, United States
  • Meyers, Kevin E.C., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Samuels, Joshua A., University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Urbina, Elaine M., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Group or Team Name

  • The SHIP AHOY Investigators
Background

Ambulatory blood pressure monitoring (ABPM) is increasingly utilized for the diagnosis of hypertension (HTN). While adult guidelines use absolute blood pressure (BP) cut points to define ambulatory HTN, current pediatric guidelines define ambulatory HTN based on a sex- and height-specific 95th percentile derived from limited pediatric normative data, in which many tall adolescents have a threshold for HTN higher than adult cut-points.

Methods

We compared absolute ABP values with sex- and height-specific ABP percentiles as predictors of left ventricular hypertrophy (LVH) in youth. We measured casual BP, ABPM, anthropometrics, and echo for LV mass index (LVMI) in 357 adolescents (mean age 15.5 +1.7 years, 63% white, 59% male). ABPM was performed with Ontrak device (Spacelabs Inc., Snoqualmie, WA). ABP index was defined as mean ABP/sex- and height-specific 95th percentile. LVH was defined as LVMI ≥38.6 g/m2.7 (pediatric cut-point). Logistic regression was used to assess different ABP measures as predictors of LVH. Sensitivity and specificity of different ABP cut points as predictors of LVH were calculated.

Results

Seventy participants (19.6%) had LVH. Systolic 24-hour, wake and sleep mean BPs and indexes were all significantly associated with LVH. The C-statistics for absolute 24-hour (AUC 0.642 vs. 0.612, p=0.042) and wake (AUC 0.628 vs. 0.590, p=0.03) SBP predicted LVH better than SBP indexes of the same time periods. Absolute SBP cut points also had better balanced sensitivities and specificities in predicting LVH (24-hour SBP 120: 66% and 61%; wake SBP 125: 63% and 59%; sleep 110: 61% and 61%). There was no significant association between diastolic BP measures and LVH.

Conclusion

A single static cut-point using absolute ambulatory SBP is non-inferior to sex-and height- based SBP percentile in predicting LVH in youth. The cut-points for 24-hour and wake ABPM are lower than those for adults but may be used to define ambulatory HTN in this population.

Funding

  • Private Foundation Support