Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes

Basalely, Abby; Hill-Horowitz, Taylor; Sethna, Christine B.

doi:10.1007/s11906-022-01231-3

Cited by 5 publications

(4 citation statements)

References 68 publications

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“…This study’s concentration on prehypertensive adolescents with a median age of 16 (IQR, 14–17) may have driven the significant association of height and sex with reclassification phenotype. The 95th percentile blood pressures for tall adolescent males are greater than adult thresholds, making these adolescents the most likely to reclassify to hypertension [ 8 ]. For example, a 175 cm, 17-year-old boy with an average wake systolic blood pressure of 135 mmHg was not hypertensive according to the 2014 AHA pediatric ABPM guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…For example, a 175 cm, 17-year-old boy with an average wake systolic blood pressure of 135 mmHg was not hypertensive according to the 2014 AHA pediatric ABPM guidelines. However, according to the 2022 definitions of ABPM phenotypes, he would be diagnosed with ambulatory hypertension [ 8 ]. Therefore, adolescent cohorts may be more likely to demonstrate the significant association of height and sex with reclassification phenotype by the 2022 AHA pediatric ABPM guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging data from the Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth (SHIP-AHOY) have shown that adult ambulatory cutoffs have increased sensitivity and specificity to detect left ventricular hypertrophy (LVH) in adolescents as compared to pediatric thresholds of the 95th percentile blood pressures [ 6 ]. The incongruence of adult blood pressure thresholds and hypertensive phenotypes with pediatric ABPM interpretation schema prompted the updated AHA guidelines to eliminate the phenotype of prehypertension from ABPM diagnostic criteria and lower the threshold for a diagnosis of pediatric hypertension to align with adult definitions [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines

Hill-Horowitz

Merchant

Reyes

et al. 2023

Preprint

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Background The 2022 American Heart Association (AHA) pediatric ambulatory blood pressure monitoring (ABPM) guidelines eliminated the prehypertension phenotype and blood pressure loads in ABPM interpretation criteria. Adolescents who were prehypertensive or unclassified according to the 2014 AHA pediatric ABPM guidelines will be reclassified as having hypertension or normotension. The epidemiology and association of reclassification phenotype with target organ damage (TOD) is not yet known. Methods A single center retrospective review of adolescents ages 13–21 years old between 2015–2022 was performed. Adolescents diagnosed with prehypertension or unclassified by the 2014 AHA pediatric ABPM guidelines were reclassified by the 2022 definitions. Logistic regression models adjusted for body mass index z-score evaluated the association of reclassification phenotype with left ventricular hypertrophy (LVH). Results Among 88 adolescents with prehypertension, 68% (N = 60) were reclassified as hypertensive. The majority (58%, N = 35) of hypertensive reclassification was based on isolated nocturnal blood pressures ≥ 110/65 mmHg. Taller males were more likely to reclassify as hypertensive. Adolescents reclassified as hypertensive had a greater-than-six-fold increased odds of LVH in adjusted models [OR 6.4 95%CI 1.2–33.0, p = 0.027]. Of 40 adolescents with unclassified blood pressures, 37.5% (N = 15) reclassified to normotension. There were no significant clinical or demographic variables associated with reclassification category nor was there an association with LVH. Conclusions The new ABPM guidelines effectively reclassify adolescents who were previously prehypertensive as normotensive or hypertensive based on risk of TOD. Further studies are needed to describe the long-term outcomes of ABPM phenotypes with the implementation of these guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines

Hill-Horowitz

Merchant

Reyes

et al. 2023

Preprint

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“…Ambulatory hypertension was de ned as having a mean systolic and/or diastolic BP over the 95th percentile and a systolic and/or diastolic BP load between 25-50%. Patients were classi ed as non-dipper in the absence of a drop of ≥ 10% BP at night time when compared to daytime [12].…”

Section: Assessment Of Blood Pressurementioning

confidence: 99%

Evaluation of endothelial dysfunction in hypertensive children and adolescents

Doğan,

Başar,

Aytaç

et al. 2023

Pediatr Nephrol

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Background Atherosclerotic changes can be attributed to early endothelial damage in individuals with hypertension. We aimed to explore the relationship between endothelial dysfunction and hypertension in children, considering CIMT, FMD, and functional capillaroscopy parameters. We also analyzed the differences between dipper and non-dipper patients.Methods In this cross-sectional study, 20 patients diagnosed with essential hypertension with no target organ damage, such as retinopathy and left ventricular hypertrophy, were enrolled. The patient group comprised newly diagnosed hypertensive individuals not receiving antihypertensive treatment. All evaluations were done before starting antihypertensive therapy. Hypertensive patients were divided into two groups (dipper and non-dipper patients). As a control group, 20 age and sex-matched healthy volunteers were included. Three manual CIMT measurements were taken in each carotid artery and averaged. Basal brachial artery FMD and functional capillaroscopy density were assessed, and postprovocation measurements were obtained after in ating the sphygmomanometer cuff 40-50 mmHg above basal blood systolic pressure.ResultsAmong the patients, 11 were boys, and 9 were girls, with a median age of 16.0 (11.2-17.7) years. Signi cant differences were observed between the hypertensive patients and controls in terms of CIMT (p = 0.04), brachial artery FMD (p = 0.02), and capillary density (p <0.001). Hypertensive patients exhibited increased CIMT, reduced brachial artery FMD, and lower capillary density. However, no signi cant differences were found between the dipper and non-dipper hypertensive groups.Conclusions Understanding the vascular consequences associated with essential hypertension emphasizes the importance of early detection and management of hypertension to mitigate its adverse effects on vascular structure and function. Further research is warranted to elucidate the underlying mechanisms driving these vascular changes and explore potential therapeutic interventions to restore normal vascular physiology in hypertensive individuals.

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Update on Ambulatory Blood Pressure Monitoring in Children

Singh,

Yamaguchi

2023

Curr Treat Options Peds

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Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes

Cited by 5 publications

References 68 publications

Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines

Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines

Evaluation of endothelial dysfunction in hypertensive children and adolescents

Update on Ambulatory Blood Pressure Monitoring in Children

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