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Abstract: PO2078

Pediatric vs. Adult Ambulatory Blood Pressure Monitoring (ABPM) Criteria for the Diagnosis of Hypertension (HTN) and Detection of Left Ventricular Hypertrophy (LVH) in Adolescents

Session Information

Category: Hypertension and CVD

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

Authors

  • Merchant, Kumail, Cohen Children's Medical Center, Queens, New York, United States
  • Shah, Paras P., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Singer, Pamela, Cohen Children's Medical Center, Queens, New York, United States
  • Castellanos, Laura J., Cohen Children's Medical Center, Queens, New York, United States
  • Sethna, Christine B., Cohen Children's Medical Center, Queens, New York, United States
Background

Normative values for clinic blood pressure (BP) measurements in adolescents were recently updated to align with adult HTN guidelines (CPG 2017). However, the most widely accepted pediatric normative values used to diagnose HTN by ABPM criteria have not been updated. The objective of this study was to compare pediatric ABPM criteria (pHTN) vs. adult ABPM criteria (aHTN) for the diagnosis of HTN and detection of LVH in adolescents.

Methods

ABPM and ECHO reports from adolescents age 13-21 years performed from 2015-2019 at a single center were analyzed. The concordance of HTN diagnosis based on pHTN (AHA 2014) was compared to aHTN from ACC/AHA 2017 (overall BP >125/75mmHg, wake BP >130/80mmHg, sleep BP >110/65mmHg) using Cohen’s kappa statistic. Logistic regression adjusted for body mass index (BMI) z-score and receiver operating curves (ROC) were used to compare the ability of pHTN vs. aHTN to predict LVH (left ventricular mass index [LVMI] >95th%ile reference values and LVMI >51g/m2.7).

Results

Of 306 adolescents (15.9±1.86 years, 73.5% male), 140 (45.8%) had HTN based on pHTN compared to 228 (74.5%) based on aHTN. There was poor agreement in the diagnosis of HTN between pHTN and aHTN (59.3%, N=137, kappa 0.41). 1.0% (N=3) had HTN by pHTN only while 29.7% (N=91) had HTN by aHTN only. Although a higher prevalence of LVH was captured by aHTN only, 9 (5.6%) adolescents who had LVH >95th%ile did not have HTN by either criteria. In logistic regression, adjusted for BMI z-score, there were no significant differences between pHTN and aHTN in the detection of LVH >95th%ile (OR 1.24, CI: 0.66-2.31, p=0.51) or >51g/m2.7 (OR 1.06, CI: 0.47-2.40, p=0.89). ROCs for pHTN were not significant for detecting LVH >95th%ile (0.50, p=0.91) or >51g/m2.7 (0.55, p=0.45). However, the ROC for aHTN was significant for detecting LVH >95th%ile (0.59, p=0.045) but not >51g/m2.7 (0.63, p=0.07).

Conclusion

There is poor concordance between pHTN and aHTN for the diagnosis of HTN in adolescents. aHTN appears to better predict LVH than pHTN, although neither criteria diagnosed all patients who had LVH. A consideration to align the ABPM criteria for the diagnosis of HTN in adolescents with adult guidelines is warranted.