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Abstract: PO2088

Hypertension with Target Organ Damage and Discrepancy Between Ambulatory Blood Pressure Monitoring and Exercise Blood Pressure Results: A Pediatric Case Series

Session Information

Category: Trainee Case Report

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Nwaogazie, Uche Eziaku, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
  • Krishnan, Sonia M., University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
  • Varga, Peter, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
Introduction

The prevalence of hypertension is increasing worldwide in the Pediatric population. Ambulatory blood pressure monitoring (ABPM) is recommended by the American Academy of Pediatrics (AAP) for the screening and management of pediatric hypertension. ABPM has been shown to correlate with target organ damage and provides a more reliable assessment of blood pressure (BP) control compared to clinic BP. Exercise stress testing (EST) is not recommend by the AAP for the evaluation of hypertension although anecdotally, it is used frequently by pediatric cardiologists. Despite this, reports in adults show an association between exaggerated exercise systolic blood pressure (EESP) and cardiovascular mortality and morbidity, masked hypertension, and target organ damage. We report 2 pediatric patients with hypertension and evidence of target organ damage, but with a discrepancy between their ABPM and EST BP results.

Case Description

See table below.

Discussion

We describe 2 adolescent cases of hypertension diagnosed by clinic BP and target organ damage but not confirmed by ABPM. Both patients had EST done as part of their evaluation because they were first seen by cardiologists at the study center who frequently employ EST as part of evaluation for hypertension.The cut-off value of 180mmHg for EESP was employed in this report as a previous study had identified 181 mmHg as the most discriminatory systolic BP threshold for predicting hypertension at follow-up.
The discrepant results between the ABPM and EST BP in our patients with target organ damage may indicate that multiple diagnostic tools may be required to confirm the diagnosis of hypertension. Both tests could be viewed as complimentary as ABPM is not recommended during exercise which is a part of everyday life. Furthermore, a normal ABPM may not exclude a diagnosis of hypertension in patients with elevated clinic BP and target organ damage. Further studies are needed to confirm these findings in a larger population, and to better understand how these 2 tests may perhaps be used adjunctively to diagnose hypertension.

Case Description
CasesAge/Sex/RaceClinical presentationWeight/Height/BMI/Clinic BPCardiology Work-upRenal Work-upTreatment and Outcome
116y/Male/HispanicElevated BP86kg/173.7cm/ 28.5kg/m2(96th percentile)/131/81mmHgEKG: NSR
ECHO: Mild LV hypertrophy
EST: Protocol: BRUCE (peds)
Max BP: 191/61 mmHg
Max workload: 13.4 METS
Exaggerated BP response
Cr: 0.85mg/dl
Urinalysis: Normal
Pr/Cr: 0.08
cANCA: <1:20
ABPM: Normal
Retroperitoneal USS with doppler: Normal
He received HCT for about 1 month and continued lifestyle modification. Resolution of PAMM lesions and Retinal vein occlusion.
His BP at his last visit was 125/80mmHg.
214y/Male/African AmericanFainting during exercise70.9kg/169.3cm/ 24.7kg/m2(93rd percentile)/130/82mmHgEKG: NSR
ECHO: Mild LVH with increased LV mass-154g/m2.
Protocol: BRUCE (Peds)
Max BP: 209/051 mmHg
Max workload: 11.6 METS
Repeat EST BP:192/62mmHg.
Cr:0.87mg/dl
Urinalysis: Normal
Pr/Cr:0.05
Aldosterone:4.2ng/dl
Renin:0.2ng/ml/hr
Retroperitoneal USS with doppler: Normal
There was resolution of LVH and increased LV mass on repeat ECHO prior to starting antihypertensives.
Low dose lisinopril was started due to EESP. His BP at last visit was 144/85mmHg.

PAMM: Paracentral acute middle maculopathy, HCT: Hydrochlorothiazide