2 - Association of age, blood pressure severity, and target organ injury with secondary vs. primary hypertension in youth referred for hypertension disorders: Interim analysis of the SUPERHERO Registry

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 2
Publication Number: 2.321

Donald J. Weaver, Levine Children's Hospital, Charlotte, NC, United States; Shupti Biswas, Cohen Children's Medical Center, Floral Park, NY, United States; Aaron M. Bridges, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Wilkesboro, NC, United States; Lucy D'Agostino McGowan, Wake Forest University, Winston Salem, NC, United States; Victoria Giammattei, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, winston-Salem, NC, United States; Margret Kamel, Emory University School of Medicine, Atlanta, GA, United States; Stefan G. Kiessling, Kentucky Children's Hospital, Lexington, KY, United States; John R. Laisure, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Clemmons, NC, United States; Jackson T. Londeree, Emory, Atlanta, GA, United States; Caroline B. Lucas, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Jason Misurac, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Margaret Murphy, University of Kentucky College of Medicine, Lexington, KY, United States; Sandeep Riar, Emory University School of Medicine, Atlanta, GA, United States; Christine Sethna, Cohen Children’s Medical Center, New Hyde Park, NY, United States; Irina Viviano, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Ikuyo Yamaguchi, Oklahoma Childrens Hospital at OU Health, Oklahoma city, OK, United States; Andrew M.. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Presenting Author(s)

DW

Donald J. Weaver, Jr., MD, PhD (he/him/his)

Clinical Professor of Pediatrics
Levine Children's Hospital
Charlotte, North Carolina, United States

Background: Secondary HTN is often thought to be the main cause of HTN in young children and those with more severe HTN. However, the rising incidence of primary HTN has called this into question.

Objective: Our objective was to estimate risk of secondary HTN based on participant age, BP, and target organ injury at the index visit.

Design/Methods: Interim analysis of baseline data from Phase 1.1 of The Study of the Epidemiology of Pediatric Hypertension (SUPERHERO) Registry, a multisite retrospective cohort using electronic health records data. Inclusion criteria were initial visit for HTN disorder based on ICD-10 codes between 1/1/2015 and 12/31/2021 and age < 19 years. Exclusion criteria were kidney transplant, dialysis, or pregnancy per ICD-10 codes at the index visit. Exposures were age, BP severity, and presence of ICD-10 codes for heart and kidney target organ injury at the index visit. Outcomes were primary vs. secondary HTN by ICD-10 codes at the index visit. We used Welch’s two-sample t-test and unadjusted generalized linear models to estimate risk.

Results: Median age was 12.4 + 4.9 years, 48% (2003/4212) had obesity, 88% (3305/4212) had primary HTN and 22% had secondary HTN (907/4212) (Table). Compared to youth < 13 years old, adolescents had 39% lower risk of secondary vs. primary HTN (95% CL 0.54-0.68). Participants with secondary hypertension had a 28% lower risk of severe hypertension compared to those with primary hypertension (95% CI 0.64-0.82). Participants with secondary hypertension were 1.6 times more likely to develop target organ injury compared to those with primary hypertension (95% CI 1.33-1.9).

Conclusion(s):

In a large multicenter cohort of youth referred for hypertension disorders, we found that older age was associated with lower risk of secondary HTN. In addition, more severe hypertension was associated with a lower risk of secondary HTN despite a significantly increased risk for target organ injury in participants with secondary HTN. Further studies are needed to better define clinical factors that differentiate primary and secondary HTN to facilitate management and to minimize this increased risk of target organ injury.