Impact of the 2022 American Heart Association pediatric ambulatory blood pressure monitoring statement on the diagnosis of hypertension

Abstract

Background The diagnosis of hypertension and hypertension-induced target organ injury by the 2022 American Heart Association (AHA) ambulatory blood pressure threshold as compared with 2014 AHA and 2016 European Society of Hypertension (ESH) thresholds has not been evaluated. Methods In a cross-sectional study (n = 291, aged 5-18 years, at a tertiary care outpatient clinic), we compared 2022 AHA with 2014 AHA and ESH thresholds (revised with 2018 adult ESH thresholds where applicable) to diagnose ambulatory hypertension (AH), and detect ambulatory arterial stiffness index (AASI) and left ventricular target organ injury (LVTOI). ResultsThe 2022 AHA threshold diagnosed significantly more AH (53%) than the 2014 AHA (42%, p < 0.01) and ESH (36%, p < 0.001) thresholds. The 2022 AHA threshold demonstrated only a moderate agreement with the 2014 AHA (kappa (k) = 0.77) and ESH (k = 0.66) thresholds to diagnose AH. Adjusted logistic regression analysis found that only the 2022 AHA threshold predicted elevated AASI significantly (odds ratio 2.40, 95% CI 1.09, 5.25, p = 0.02; AUC 0.61, p < 0.01). In those with elevated AASI, more participants had AH by the 2022 AHA threshold (72%) than the 2014 AHA (46%, p = 0.02) and ESH (48%, p = 0.03) thresholds. AH defined by the 2022 AHA threshold continued to maintain higher odds, larger AUC, and higher sensitivity to identify LVTOI than the 2014 AHA and ESH thresholds; however, the difference did not reach a statistically significant level. Conclusions AH defined by the 2022 AHA threshold diagnoses more children with hypertension and identifies more children with hypertension-induced target organ injury than the 2014 AHA and ESH thresholds.

Childhood Primary Hypertension: Not Uncommon, Not Benign

“…The meta-analysis confirms what has been suggested by previous single-center studies that ambulatory blood pressure monitoring is well suited for identification of patients with hypertensive target organ damage. 4 The findings of the meta-analysis, namely that hypertension was associated with all examined markers of TOD compared to normotension, further adds clarity to the risks of primary hypertension in the young. These findings should dispel any doubt that TOD is commonly present among children and adolescents with primary hypertension.…”

“…The meta-analysis confirms what has been suggested by previous single-center studies that ambulatory blood pressure monitoring is well suited for identification of patients with hypertensive target organ damage. 4…”

Hipertensión Arterial en Pediatría. Rol de la Monitorización Ambulatoria de Presión Arterial (MAPA)Hipertensión Arterial en Pediatría. Rol de la Monitorización Ambulatoria de Presión Arterial (MAPA)

“…9 realizó una comparación en la interpretación de MAPA usando valores AHA del 2014, 2022 y valores Europeos 2016 en 291 niños con edades entre 5 y 18 años. Sus resultados mostraron un mayor diagnóstico de hipertensión ambulatoria usando los valores 2022 (52% vs 42%) y mayor número de niños con DOB, como hipertrofia de ventrículo izquierdo (HVI) y alteraciones del grosor de la íntima media carotídea (IMT) 9 .…”

“…Con las nuevas recomendaciones, además de aumentar el diagnóstico de HTA, aumenta la sensibilidad y especificidad para la pesquisa de HVI 11 por lo tanto, al diagnosticar más pacientes con HTA, tendremos más búsqueda activa de DOB y consecuentemente un mayor diagnóstico de HVI 9 .…”

“…En la edad pediátrica, la presencia de HTA y su asociación con HVI está descrita en 14-43%. La diferencia de porcentaje se puede explicar dado los distintos modelos de indexación de la MVI y los percentiles usados para definir HVI (IMVI > p95 para edad y género o HVI severa definida como IMVI > 51 g/m 2.7 ) 9 . En un estudio chileno de 192 niños y niñas de 6-13 años hipertensos, se encontró sólo un 1.2% con HVI, definida como IMVI >51g/m 2.7 32 .…”