Correlation Between Ambulatory Blood Pressure Monitoring and Target Organ Damage in Children
Musa Öztürk1, Batuhan Bakırarar2, Zeynep Birsin Özçakar3
1Department of Pediatrics, Ankara University Faculty of Medicine, Ankara 06100, Türkiye.
Insights
Higher ambulatory systolic blood pressure (BP) in children is linked to left ventricular hypertrophy (LVH), a key indicator of heart damage. Ambulatory blood pressure monitoring (ABPM) may help identify children at risk for target organ damage.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Diagnostic Tools in Pediatrics
Background:
- Ambulatory blood pressure monitoring (ABPM) provides detailed insights into blood pressure (BP) patterns and hypertension in children.
- Left ventricular hypertrophy (LVH) and hypertensive retinopathy (HRP) are significant target organ damages (TOD) associated with pediatric hypertension.
- Understanding the relationship between ABPM parameters and TOD is crucial for early detection and management.
Purpose of the Study:
- To investigate the association between ABPM parameters and the presence of LVH and HRP in hypertensive children.
- To identify potential ABPM thresholds indicative of TOD in pediatric hypertension.
- To compare the efficacy of different statistical and machine learning models in predicting TOD.
Main Methods:
- A retrospective analysis of 269 children with hypertension who underwent ABPM.
- Multivariable logistic regression to assess the link between BP Z scores and TOD, controlling for covariates.
- Machine learning models (logistic regression, random forest, multilayer perceptron) were employed with 10-fold cross-validation.
Main Results:
- LVH was present in 18% of patients, and HRP in 9%.
- A higher 24-hour systolic BP Z-score was independently associated with LVH (aOR 1.44, p=0.001).
- No ABPM parameter showed an independent association with retinopathy; predictive model performance was limited.
Conclusions:
- Elevated ambulatory systolic BP is linked to LVH in children but not retinopathy.
- ABPM thresholds (≥90th percentile, ≥25% systolic load) may aid in identifying children at risk for TOD.
- These findings require prospective validation to confirm their clinical utility.
Background:
Ambulatory blood pressure monitoring (ABPM) offers a comprehensive assessment of mean blood pressure (BP), circadian patterns, and out-of-office hypertension phenotypes. We evaluated the association of ABPM parameters with left ventricular hypertrophy (LVH) and hypertensive retinopathy (HRP) in children with hypertension.
Methods:
This retrospective analysis included 269 children who underwent ABPM at a tertiary care facility. Multivariable logistic regression was used to evaluate associations between BP Z scores and target organ damage (TOD), adjusting for age, sex, and body mass index standard deviation score. Machine learning techniques (logistic regression, random forest, and multilayer perceptron) were also evaluated using 10-fold cross-validation across exploratory combinations of the 90th or 95th percentiles and BP-load thresholds of 25% or 50%.
Results:
LVH was detected in 45/247 patients (18%) and HRP was observed in 22/240 patients (9%). The 24 h systolic BP Z score was independently associated with LVH (adjusted OR 1.44; 95% CI 1.16-1.80; p = 0.001). Cohort-derived systolic Z-score thresholds for LVH were 1.31 for 24 h systolic BP and 1.47 for nighttime systolic BP, corresponding to approximately the 90.6th and 93rd percentiles, respectively. No variable evaluated was independently associated with retinopathy. Logistic regression using the 90th percentile/25% load dataset showed the highest performance among the evaluated classifiers, but discrimination was limited (ROC area 0.603; MCC 0.041).
Conclusions:
Higher ambulatory systolic BP was independently associated with LVH but not with clinically detected hypertensive retinopathy. ABPM values at or above the 90th percentile and a systolic load of ≥25% may help identify children at increased risk of TOD, although these thresholds remain exploratory and require prospective external validation.
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