Abstract: FR-PO742
Diagnosis of Hypertension in Children Using Ambulatory Blood Pressure Monitoring
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Chati, Priyanka, Inova Fairfax Hospital, Falls Church, Virginia, United States
- Amin, Rasheda, Inova Fairfax Hospital, Falls Church, Virginia, United States
Background
24-hour ambulatory blood pressure monitoring (ABPM) is becoming standard practice for diagnosis of hypertension (HTN) in pediatrics. ABPM is used to confirm HTN or white coat hypertension (WCH) in patients with office-based elevated BP readings, masked hypertension (MH) in high-risk populations and to assess treatment efficacy in patients with HTN. We describe the experience of a pediatric subspecialty clinic in improving utilization of ABPM by 2000% in 4 years, using limited resources and staff, and breakdown of diagnoses based on the procedure.
Methods
In April 2017, a formal ABPM program was set up by the pediatric nephrology division, comprising 2.0 FTE physicians and 1.5 FTE nurses, at a pediatric specialty practice. Outdated ABPM monitors were replaced by 3 new Spacelabs OnTrak devices. Nephrologists and nurses were trained to use new equipment. ABPM was promoted amongst community pediatricians and cardiologists through grand rounds, fliers and talks. New and established patients underwent ABPM with nurses or physicians performing procedures. Standard parameters of mean BP, BP load and nocturnal dipping were compared with normative pediatric data to determine normal or elevated BP by physicians. Those with no definitive diagnosis were labeled as concerns.
Results
The number of ABPM procedures increased from 6 procedures/year in 2017 to 125 procedures/year in 2021 – an increase of 2000%. During the years 2018-2021, a total of 315 ABPM procedures were performed (Figure 1). HTN was diagnosed in 96, WCH in 91 and MH in 7 patients. Poorly controlled HTN was found in 21 of 53 patients with known HTN. 71 patients who had concerning or indeterminate studies were asked to repeat the study.
Conclusion
We successfully set up an ABPM program and increased its utilization with limited resources and staff. We increased the number of patients undergoing ABPM and improved diagnosis of patients with HTN, WCH, MH and those with poorly controlled HTN with a goal to better identify and manage HTN.
Figure 1: ABPM Based Diagnosis over 4 years