8 - Changes in Prevalence and Phenotype of Pediatric Hypertension in Children Suspected of Hypertension using the 2022 American Heart Association Guidelines
2nd year pediatric nephrology fellow Faculty of medicine, Ramathibodi Hospital, Mahidol university bangkok, Krung Thep, Thailand
Background: For diagnosis of hypertension by ambulatory blood pressure monitoring (ABPM), the 2014 American Heart Association (AHA) guidelines recommended to use the 95th percentile criteria for gender and height while the 2022 AHA guidelines recommended to use the adult ABPM cut-off criteria in children age ≥13 years. Objective: The present study aimed to evaluate the effects of the 2022 AHA guidelines on the changes in prevalence and phenotype of hypertension in children with suspected of hypertension. Design/Methods: Consecutive children suspected of hypertension who underwent 24-hour ABPM were recruited. Baseline characteristics, office blood pressure and ABPM results were collected. Patients were separated into 3 groups, including the escalated, de-escalated and unchanged groups. The escalated group included patients with normotension or prehypertension by the 2014 AHA guidelines but were escalated into masked hypertension or sustained hypertension by the 2022 AHA guidelines. The de-escalated group included patients with prehypertension by the 2014 AHA guidelines but were de-escalated into normotension or white-coat hypertension by the 2022 AHA guidelines. The unchanged group included patients who had the same diagnosis from both guidelines. Demographic data were compared between the 3 groups. Logistic regression analysis was performed to evaluate the factors associated with the escalation in the diagnosis of hypertension. Results: Among 100 children, abnormal ABPM results were detected in 61 and 48 children according to the 2022 and 2014 AHA guidelines, respectively. Prevalence of sustained hypertension, masked hypertension and white-coat hypertension were increased when using the 2022 AHA guidelines compared to the 2014 AHA guidelines; 43% to 48%, 5% to 13% and 12% to 29%, respectively. Thirteen patients were in the escalated group while 20 patients were in the de-escalated group. All patients in the escalated group were male, with an older age (14.8 vs 13.6 years, p=0.01) and a taller height (174 vs 161 cm, p< 0.01) than those of the unchanged group. Height was the only independent factor associated with the escalation in the diagnosis of hypertension. Four patients (30%) in the escalated group had left ventricular hypertrophy (LVH) at the time of ABPM measurement.
Conclusion(s): Using the 2022 AHA guidelines increased the prevalence of hypertension and detected more patients with end-organ damage. The escalation in the diagnosis of hypertension was seen in tall males.
