ESPN 53rd Annual Meeting

ESPN 2021


 
A fixed blood pressure cut-off approach to blood pressure interpretation in children
ROBERT L. MYETTE 1 JANUSZ FEBER 1

1- CHILDRENS HOSPITAL OF EASTERN ONTARIO, OTTAWA, ONTARIO, CANADA
 
Introduction:

Current pediatric hypertension definitions are based on a child’s height, age and sex, and are complex. A more simplified method includes using fixed blood pressure cut-offs (fBPc). We sought to determine the performance of the blood pressure definition using fBPc, when compared to the complex, percentile-based definitions. 

Material and methods:

We consecutively enrolled all pediatric patients, aged 5-18 years, who underwent ambulatory blood pressure monitoring (ABPM) in the last 10 years. All patients had 3 consecutive oscillometric office blood pressure readings within 90 days of their ABPM. Office normotension/hypertension was defined using: CAN1: Canadian pediatric hypertension guidelines 2020 (fBPc, age <12, 120/80 mmHg, age >=12, 130/85 mmHg); CAN2 (percentiles all ages), AAP (percentiles up to 13 years, >130/80 mmHg thereafter) and ESH (percentiles up to 16 years, >140/90 mmHg thereafter). We tested agreement between CAN1, CAN2, AAP, and ESH using Cohen’s Kappa, and their ability to predict daytime ambulatory hypertension (daytime SBP or daytime DBP Z-score>1.65) using AUC. Further, we analyzed LVMi (g/m2.7) to ascertain differences in target organ damage (TOD) between groups.

Results:

Two-hundred and ninety-three children (male=157) were included in the study. Using Cohen’s Kappa, we noted substantial agreement between CAN1:CAN2 (k=0.70), CAN1:AAP (k=0.75) but only moderate agreement between CAN1:ESH (k=0.46). Predictive power (AUC) of daytime ambulatory hypertension was: CAN1=0.58, CAN2=0.54, AAP=0.53 and ESH=0.56. There were no significant differences in LVMi between CAN1 and CAN2, AAP, or ESH.

Conclusions:

There was substantial agreement between hypertension diagnosis using a fBPc (CAN1), and the more complex percentile-based definitions (CAN2, AAP); with only moderate agreement with ESH. The prediction of ambulatory daytime hypertension was limited. There were no differences in LVMi between groups, suggesting that the use of an age-dependent, fBPc definition of hypertension may be equivalent to more complex, percentile-based definitions while not leading to underdiagnosis of TOD.