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Defining systolic blood pressure normative values in hospitalized pediatric patients: a single center experience
Amanda M Uber1, Jialin Han2, Paul Grimm3
1Department of Nephrology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
Insights
Hospitalized children show higher blood pressure (BP) than outpatient norms, making existing hypertension definitions unreliable for inpatient care. This study provides new BP centile curves for hospitalized pediatric patients to guide clinical management.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Children
- Clinical Pediatrics
Background:
- Outpatient blood pressure (BP) norms and hypertension (HTN) definitions are inadequate for initiating inpatient therapy in children.
- There is a lack of established normative data for hypertension in hospitalized pediatric populations.
- This study addresses the need for specific BP guidelines for pediatric inpatients.
Purpose of the Study:
- To determine the prevalence of hypertension in hospitalized children.
- To generate normative blood pressure values for pediatric patients during hospitalization.
- To provide a basis for initiating inpatient therapy and managing pediatric hypertension.
Main Methods:
- A cross-sectional observational study was conducted at Stanford Children's Hospital.
- The study included 7468 hospital encounters of children aged 2 to <18 years from 2014-2018.
- Over 118,000 automated oscillometric BP measurements were analyzed from hospitalizations exceeding 24 hours.
Main Results:
- The prevalence of HTN, using outpatient guidelines, ranged from 12-48% in boys and 6-39% in girls.
- Stage 1 systolic HTN affected 12-38% of boys and 6-31% of girls; Stage 2 affected 3-10% of boys and 1-8% of girls.
- Derived centile curves indicated significantly higher BP readings in hospitalized children compared to outpatient settings.
Conclusions:
- Hospitalized children exhibit higher blood pressures than those in ambulatory settings.
- Outpatient BP norms are unreliable for guiding inpatient therapy initiation in pediatric populations.
- The study's generated centile curves offer crucial guidance for clinicians managing hospitalized pediatric patients.
Background:
Normative blood pressure (BP) values and definition of hypertension (HTN) in children in outpatient setting cannot be reliably used for inpatient therapy initiation. No normative exists to describe HTN in hospitalized pediatric populations. We aimed to study the prevalence of hypertension and produce normative BP values in hospitalized children.
Methods:
Cross sectional observational study of all children hospitalized on acute care floors, ≥2 and <18 years age, at Stanford Children's Hospital, from Jan-01-2014 to Dec-31-2018. Cohort included 7468 hospital encounters with a total of 118,423 automated, oscillometric, BPs measured in the upper extremity during a hospitalization of >24 hours.
Results:
Overall prevalence of HTN, defined by outpatient guidelines, was 12-48% in boys and 6-39% in girls, stage 1 systolic HTN in 12-38% of boys and 6-31% of girls, stage 2 systolic HTN in 3-10% of boys and 1-8% of girls. Centile curves were derived demonstrating overall higher BP reading for hospitalized patients compared to the outpatient setting.
Conclusion:
Higher blood pressures are anticipated during hospitalization. Thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances.
Impact:
Hospitalized children have higher blood pressures compared to patients in the ambulatory setting, hence outpatient normative blood pressure values cannot be reliably used for inpatient therapy initiation. No normative exists to describe hypertension in hospitalized pediatric populations. The thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances.
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