28 - Reclassifying Unclassified Adolescent Ambulatory Blood Pressures (BPs) by the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 28
Publication Number: 28.322

Taylor A. Hill-Horowitz, Cohen Children's Medical Center, New Hyde Park, NY, United States; Kumail Merchant, The Children’s Medical Center at NYU Winthrop Hospital, East Meadow, NY, United States; Laura Castellanos, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Pamela Singer, Cohen Children's Medical Center, Cedarhurst, NY, United States; Haripriya Dukkipati, Cohen Children's Medical Center, San Jose, CA, United States; Christine Sethna, Cohen Children’s Medical Center, New Hyde Park, NY, United States; Abby Basalely, N/A, New Hyde Park, NY, United States

Presenting Author(s)

Taylor A. Hill-Horowitz, BS (she/her/hers)

Clinical Research Coordinator
Cohen Children's Medical Center
New Hyde Park, New York, United States

Background: The 2014 AHA pediatric ABPM guidelines rendered an estimated 20–40% of adolescents unclassified as their clinic and ambulatory BPs and loads did not align with any phenotype. Their treatment was left to the clinical opinion of practitioners. The 2022 AHA pediatric ABPM guidelines eliminated BP loads from diagnostic criteria. The impact of the new guidelines on reclassification patterns for adolescents who were previously unclassified has yet to be determined.

Objective: (1) Describe the epidemiology of reclassification for adolescents who were unclassified by the 2014 AHA pediatric ABPM guidelines; (2) Evaluate the association of new diagnostic category with left ventricular hypertrophy (LVH).

Design/Methods: A retrospective chart review was performed on ABPM data from 2015-2022. Adolescents 13-21 years old whose ABPM report had >40 total readings, >1 BP measurement per hour, and >65% successful readings were included. Unclassified was defined as either clinic BP < 90^th%ile with ambulatory BP < 95^th%ile and loads >25% or clinic BP between 90^th and 95^th%ile with loads < 25%. Primary exposures were reclassification phenotypes: (1) normotension, (2) White Coat Hypertension (WCH), (3) masked hypertension, and (4) ambulatory hypertension as defined by the 2022 AHA pediatric ABPM guidelines. LVH was defined as a left ventricular mass index >95^th%ile. Pearson’s chi-squared and Wilcoxon rank-sum tests compared variables and outcomes of reclassified groups.

Results:

Of 353 adolescents, 44 were unclassified by 2014 guidelines. They were reclassified as follows: 16 normotension (36%), 9 WCH (20%), 16 masked hypertension (36%), and 3 ambulatory hypertension (7%) (Figure 1). Systolic, diastolic, wake, and sleep ambulatory BPs were higher for adolescents who reclassified as hypertensive (masked + ambulatory) than normotensive (normotension + WCH) (p< 0.05) (Table 1). There was no association between reclassification phenotype and age, sex, height, body mass index, or LVH.

Conclusion(s):

The majority of adolescents previously unclassified by 2014 guidelines were reclassified as masked hypertension or normotension. 12% of the total sample was unclassified, and nearly half (n=19, 43%) of these unclassified individuals reclassified to hypertension. These results support the 2022 AHA pediatric ABPM guidelines' removal of loads from ABPM interpretation as it ensures an applicable diagnostic category for each individual and helps to standardize follow-up. The lack of LVH prediction by this cohort may be due to small sample size. Further studies in larger cohorts are needed to determine the predictive value of reclassification.