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Abstract: TH-PO497

Association of Isolated Nocturnal Hypertension (INH) and Target Organ Damage in Light of the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines

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

  • Hill-Horowitz, Taylor Addison, Cohen Children's Medical Center, Queens, New York, United States
  • Feldman, Penina, Cohen Children's Medical Center, Queens, New York, United States
  • Frank, Rachel, Cohen Children's Medical Center, Queens, New York, United States
  • Castellanos, Laura J., Cohen Children's Medical Center, Queens, New York, United States
  • Singer, Pamela, Cohen Children's Medical Center, Queens, New York, United States
  • Sethna, Christine B., Cohen Children's Medical Center, Queens, New York, United States
  • Basalely, Abby Miriam, Cohen Children's Medical Center, Queens, New York, United States
Background

Pediatric INH, previously defined by the 2014 guidelines as sleep blood pressure (BP) >95th%ile for sex and height, is associated with increased risk of target organ damage (TOD). In 2022, AHA guidelines lowered sleep BP thresholds to 110/65mmHg. The aim was to determine the association of INH and TOD according to the new guidelines.

Methods

A retrospective chart review of ABPMs from adolescents 13-21 years old between 2015-2022 was performed. ABPM phenotypes were normotension, INH, isolated daytime hypertension (HTN), and sustained day-night HTN. The primary exposure was INH, defined as sleep BPs >110/65mmHg with wake BPs <130/80mmHg. Echocs performed within 6 months of ABPM were reviewed. The primary outcome was left ventricular hypertrophy (LVH), defined as LVMI >95th%ile. Pearson’s chi-squared, Wilcoxon rank-sum, and logistic regression were utilized as appropriate.

Results

Of 353 ABPM reports (median age 16, 73% male), 25% (N=89) classified as INH by 2014 guidelines, while 45% (N=115) classified as INH by 2022 guidelines. Hypertensive sleep BPs bordered the 110/65mmHg cutoff; median systolic BP was 116mmHg [IQR 112,122] and median diastolic BP was 62mmHg [58,68] (Table 1). Echos were available for 60% of the cohort (N=154) and 57% (N=65) of INH. LVH prevalence according to ABPM phenotype was 40% (26/65) of INH, 33% (2/6) of isolated daytime HTN, and 46% (38/83) of sustained day-night HTN. Any HTN was associated with >2x increased odds of LVH [OR=2.5 95%CI(1.2-5.2)], but there was no association of INH with LVH as compared to normotension.

Conclusion

Lack of association between INH and LVH may reflect the increased sensitivity of 2022 AHA guidelines to diagnose nocturnal HTN. LVH was less prevalent among INH as compared to other hypertensive phenotypes. While the cohort was small, these findings may inform future studies of how clinicians should manage INH.