ESPN 53rd Annual Meeting

ESPN 2021


 
RE-EVALUATING HYPERTENSION IN CHILDREN ACCORDING TO DIFFERENT GUIDELINES: A SINGLE CENTER STUDY
CEMALİYE BAŞARAN 1 BELDE KASAP DEMİR 2 MUSTAFA AGAH TEKİNDAL 3 GÖKÇEN ERFİDAN 1 ÖZGÜR ÖZDEMİR ŞİMŞEK 1 SEÇİL ARSLANSOYU ÇAMLAR 4 DEMET ALAYGUT 1 FATMA MUTLUBAŞ 4 FERHAN ELMALI 3

1- IZMIR UNIVERSITY OF HEALTH SCIENCES TEPECIK EDUCATION AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRIC NEPHROLOGY, IZMIR, TURKEY
2- IZMIR KATIP ÇELEBI UNIVERSITY MEDICAL FACULTY, DEPARTMENT OF PEDIATRICS, DIVISION OF NEPHROLOGY AND RHEUMOTOLOGY, IZMIR, TURKEY
3- IZMIR KATIP ÇELEBI UNIVERSITY FACULTY OF MEDICAL SCIENCES DEPRTMENT OF BIOSTATISTICS, IZMIR, TURKEY
4- UNIVERSITY OF HEALTH SCIENCES, IZMIR FACULTY OF MEDICINE DEPARTMENT OF PEDIATRICS, DIVISION OF NEPHROLOGY, IZMIR, TURKEY
 
Introduction:

 We aimed to evaluate the agreement between the guidelines used for both office blood pressure(OBP) and ambulatory blood pressure monitoring(ABPM). Our secondary aim was to define the best threshold to assess children at risk of left ventricular hypertrophy(LVH).  

Material and methods:

 Data of patients with ABPM betweeen October2017 and December2020 were evaluated retrospectively. Thresholds proposed by Fourth Report(FR), European Society of Hypertension(ESH) and American Academy of Pediatrics(AAP) for OBP; Wühl et al(W), ESH and American Heart Association(AHA) for ABPM were used and Nine different BP phenotype combinations were created. The agreements between the thresholds and the sensitivity(S) of the thresholds and BP phenotype to predict LVH were determined for age groups and BMI levels. 

Results:

 Of the 949 patients (M/F:502/447), 325(34.2%) were <12y, 368(38.8%) were 13-15y, and 256(27%) were 16-18y; 425(35.8%) were lean, 148(12.5%) were overweight and 376 (31.6%) were obese. Echocardiographic evaluation was available in 553 (58%) cases. The agreement between guidelines for OBP and ABPM were “good” and “very good” (κ=0.639; 95%CI, 0.638-0.640, κ=0.986; 95%CI, 0.985-0.988), respectively. To classify OBP and ABPM as normal, white coat, masked and sustained hypertension, we had nine different combinations that had “very good” agreement (κ=0.880; 95%CI, 0,879-0,880). The S of AAP for detecting LVH was the highest. The highest S was in <12-year-old obese children(S=75.8, 95%CI, 56.4-89.7) for all. The S of ABPM in detecting LVH were similar among different age and BMI groups. The lean group of 13-15y(S=88.8, 95%CI, 51.7-99.7) had the highest S for all combinations. In overweight and obese patients, the highest sensitivity was in the 13-15 age group with combinations formed according to AAP thresholds(S= 75, 95%CI, 19.4-99.3, S= 84.2, 95%CI, 60.4-96.6, respectively).

Conclusions:

 We found that AAP guideline is more sensitive and decisive for BP phenotypes in detecting LVH, especially in children ≤15 years. This is the first study evaluating BP thresholds considering LVH with the highest patient number.