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Abstract: SA-OR42

Elevated Load with Normal Mean in Pediatric Hypertension (HTN): What Does It Mean?

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Campbell, Fallon, Texas Children's Hospital, Houston, Texas, United States
  • Shah, Shweta S., Baylor College of Medicine, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
  • Sigler, Katharine, Texas Children's Hospital, Houston, Texas, United States
  • Acosta, Alisa A., Baylor College of Medicine, Houston, Texas, United States

Current pediatric ambulatory blood pressure monitor (ABPM) guidelines define HTN as mean blood pressure (BP) > 95th percentile for gender and age/height and load > 25%. Those with a normal mean BP but elevated load are “unclassifiable.” Adult ABPM criteria is based solely on mean BP using an absolute threshold. Applying pediatric versus adult ABPM criteria in adolescents has been a topic of research recently as the 2017 pediatric BP guidelines use adult norms to define clinic HTN in patients (pts) ≥ 13 years (yrs). However research on the utility of BP load in defining pediatric HTN is limited. We aimed to evaluate the significance of elevated BP load in “unclassified” pts by ABPM including association with left ventricular hypertrophy (LVH).


Retrospectively, pts 13-17 yrs with ABPM data between 9/2018 and 7/2019 were categorized by pediatric ABPM guidelines using only ABPM data. Data collected included gender, age, height, ABPM systolic and diastolic BP mean and load for 24hr, day, and night, and left ventricular mass index (LVMI). Unclassifiable pts were re-categorized to HTN or normal BP using the adult threshold for mean BP only. LVH was defined as LVMI > 51 g/m2.7.


495 pts (335 M) had ABPM. 146 had HTN; 198 (121 M) were “unclassified.” 52 pts with normal BP and 101 of unclassified pts had LVMI data. There was no significant difference in mean LVMI in pts with “unclassified” versus normal BP (41 vs 40 g/m2.7 p=0.62) nor presence of LVH (11% vs 9.6% p =0.81). Of the 198 unclassified pts, 150 (76%) were re-categorized (re-cat) to HTN by adult criteria, and there was no difference in LVMI compared to pts re-cat to normal BP (42.6 vs 39.4 g/m2.7 p=0.23). Pts re-cat to HTN, had significantly higher loads for night BP and 24 hr systolic BP compared to those with normal BP. However, there was no difference between the mean loads when comparing those with LVH versus no LVH.


For adolescents with a normal mean BP by pediatric criteria, elevated BP loads are not associated with LVH. Furthermore, applying adult criteria to define HTN would appropriately re-classify those with higher loads. Regardless, after re-classification, there is still no difference in LVMI. Applying adult ABPM standards for adolescents would simplify interpretation without sacrificing significance.