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Re-evaluating hypertension in children according to different guidelines: a single-center study

Cemaliye Basaran1, Belde Kasap Demir2,3, Mustafa Agah Tekindal4

  • 1Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey. cemaliyebasaran@gmail.com.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|April 2, 2022
PubMed

Insights

The American Academy of Pediatrics (AAP) guideline shows higher sensitivity for detecting left ventricular hypertrophy (LVH) in children, particularly normal-weight adolescents. Ambulatory blood pressure monitoring (ABPM) thresholds had limited effectiveness in this assessment.

Area of Science:

  • Pediatric Cardiology
  • Hypertension Research
  • Diagnostic Accuracy Studies

Background:

  • Office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) are crucial for diagnosing hypertension in children.
  • Discrepancies exist among various guidelines for interpreting OBP and ABPM, impacting risk stratification for conditions like left ventricular hypertrophy (LVH).
  • Accurate assessment of blood pressure phenotypes is essential for identifying children at risk of cardiovascular complications.

Purpose of the Study:

  • To evaluate the agreement between different guidelines for OBP and ABPM in children.
  • To determine the optimal blood pressure (BP) thresholds for identifying children at risk of LVH.
  • To compare the sensitivity of various BP phenotypes in predicting LVH across different age and body mass index (BMI) groups.

Main Methods:

  • Analysis of agreements between OBP and ABPM guidelines (Fourth Report, ESH, AAP, Wühl, AHA) in 949 pediatric patients.
  • Creation of nine distinct BP phenotype combinations.
  • Determination of the sensitivity of these phenotypes for predicting LVH, stratified by age and BMI.

Main Results:

  • Good to very good agreement was observed between OBP and ABPM guidelines (κ=0.639 and κ=0.986, respectively).
  • BP phenotype combinations showed very good agreement (κ=0.880).
  • The AAP guideline demonstrated the highest sensitivity for detecting LVH in <12-year-old obese children (75.8%) and normal-weight adolescents aged 13-15 years (88.8%). ABPM thresholds showed limited effectiveness.

Conclusions:

  • The AAP guideline is more sensitive and decisive for identifying children at risk of LVH, especially normal-weight children up to 15 years.
  • Ambulatory blood pressure monitoring thresholds for children appear to have a limited effect in predicting LVH compared to OBP guidelines.
  • Further research may refine BP phenotyping for improved LVH risk assessment in pediatric populations.

Keywords:
AdolescenceAmbulatory blood pressure monitoringGuidelineLeft ventricular hypertrophyhypertension

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