Abstract: TH-PO489
Evaluating Pediatric Hypertension According to Different Guidelines Using a Multi-Institutional Electronic Health Record Database
Session Information
- Pediatric Nephrology - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Liao, Wei-Ting, Chang Gung Memorial Hospital Kaohsiung Branch, Division of Pediatric Nephrology, Kaohsiung, Taiwan
- Tain, You-Lin, Chang Gung Memorial Hospital Kaohsiung Branch, Division of Pediatric Nephrology, Kaohsiung, Taiwan
Background
Childhood hypertension is associated with cardiovascular morbidity and adult mortality. However, the burden of pediatric hypertension in Taiwan remains unclear.
Methods
We conducted a cross-sectional study using outpatient blood pressure (OBP) measurements obtained in routine care visits from the Chang Gung Research Database between 2009 and 2018 to evaluate guideline defined hypertension and patient-related factors of pediatric hypertension. Additionally, we examined the agreement on hypertension between the 2017 American Academy of Pediatrics Guidelines and the 2004 Fourth Report.
Results
In total, 12,469 children and adolescents who underwent three separate >= 3 OBP measurements over 33,369 person-years with a total of 95,608 BP measurements in an outpatient setting were analyzed. According to the 2017 American Academy of Pediatrics (AAP) guidelines, the rate of pediatric hypertension in the study setting ranged from 0.78–5.95 per 1000 persons between 1 and 17 years of age. Perfect agreement existed between the thresholds of the two guidelines for defining hypertension in 1-7, 8-12 and 13-17 years of age groups (all k static >=0.85), but the use of AAP threshold classified more children as having hypertension. Children and adolescents with hypertension often had complex chronic diseases and required substantial healthcare services in outpatient, emergency, and inpatient settings.
Conclusion
The present study provides evidence of guideline-based pediatric hypertension. The study results highlight the importance of regular blood pressure monitoring to identify and management of hypertension in children and adolescents. Further research is required to investigate the effect of new thresholds on the identification of target organ damage in pediatric age.
Comparison of pediatric hypertension defined by 2004 and 2017 versions of guidelines in three age groups
| Age group, year | Number of participant | 2004 Fourth Report | 2017 AAP guideline | Differences | |||
| Number of case | Event rate / 1000 persons | Number of case | Event rate / 1000 persons | Kappa (95% CI)* | Agreement (%)** | ||
| 1-7 | 495,962 | 375 | 0.76 | 387 | 0.78 | 0.98 (0.97-0.99) | 99.58 |
| 8-12 | 255,615 | 523 | 2.05 | 573 | 2.24 | 0.94 (0.94-0.96) | 99.11 |
| 13-17 | 218,368 | 1185 | 5.43 | 1300 | 5.95 | 0.85 (0.84-0.87) | 97.44 |
American Academy of Pediatrics (AAP) *Cohen’s Kappa estimate >0.8 indicates perfect agreement ** Agreement (%) between two guidelines was calculated with as (number of cases + number of non-cases agreed in both guidelines/total participants)
Funding
- Private Foundation Support