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Ambulatory blood pressure monitoring in children: A retrospective single-center study
Mark Ahlenius1, Wouter Koek2, Ikuyo Yamaguchi3,4
1Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX, United States.
Insights
The new 2022 guidelines for 24-hour ambulatory blood pressure monitoring (ABPM) significantly increased hypertension diagnoses in children. Prior patient data could not predict ABPM hypertension, highlighting ABPM
Area of Science:
- Pediatric Nephrology
- Cardiology
- Hypertension Research
Background:
- The 2022 American Heart Association (AHA) guidelines introduced new criteria for diagnosing hypertension using 24-hour ambulatory blood pressure monitoring (ABPM).
- Previous diagnostic criteria may have underestimated the prevalence of hypertension in pediatric populations.
- Understanding the impact of these new guidelines is crucial for accurate diagnosis and management of pediatric hypertension.
Purpose of the Study:
- To compare pediatric hypertension diagnoses using the 2022 ABPM guidelines versus the 2014 guidelines.
- To assess the predictability of ABPM-diagnosed hypertension from existing patient data.
- To investigate the association between ABPM readings and left ventricular mass index (LVMI) in pediatric patients.
Main Methods:
- A single-center retrospective study was conducted on pediatric patients evaluated for elevated blood pressure between 2015 and 2018.
- Logistic regression models were used to predict hypertension diagnoses from prior patient data.
- Regression models, including BP indices and their standard deviations, were employed to predict LVMI from ABPM data.
Main Results:
- The 2022 ABPM guidelines resulted in a significant increase in hypertension diagnoses, with 51% of patients meeting criteria compared to 21% under the 2014 guidelines.
- Prior patient data did not predict ABPM-diagnosed hypertension (Nagelkerke's R² = 0.04).
- The standard deviation of wake systolic and diastolic blood pressure (BP) was significantly associated with increased LVMI, but BP indices alone were not.
Conclusions:
- The updated 2022 ABPM guidelines substantially increase hypertension diagnoses in pediatric patients.
- ABPM remains the gold standard for hypertension diagnosis in children, as prior data is insufficient for prediction.
- Blood pressure variability, as detected by ABPM, is linked to increased LVMI in pediatric patients, consistent with adult studies.
Objectives:
(1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO).
Study Design:
Single-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP.
Results:
With the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R 2 = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not.
Conclusions:
In our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertrophy.
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