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Sharma AP, Kirpalani A, Sharma A, Altamirano-Diaz L, Filler G, Norozi K. Impact of the 2022 American Heart Association pediatric ambulatory blood pressure monitoring statement on the diagnosis of hypertension. Pediatr Nephrol 2023; 38:2741-2751. [PMID: 36692729 DOI: 10.1007/s00467-022-05856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
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). RESULTS The 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. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ajay P Sharma
- University of Western Ontario, London, ON, Canada.
- Division of Nephrology, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A5W9, Canada.
| | - Amrit Kirpalani
- University of Western Ontario, London, ON, Canada
- Division of Nephrology, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - Ajaya Sharma
- University of Western Ontario, London, ON, Canada
| | - Luis Altamirano-Diaz
- University of Western Ontario, London, ON, Canada
- Division of Cardiology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Guido Filler
- University of Western Ontario, London, ON, Canada
- Division of Nephrology, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - Kambiz Norozi
- University of Western Ontario, London, ON, Canada
- Division of Cardiology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
- Department of Pediatric Cardiology and Intensive Care, Medical School, Hannover, Germany
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Basaran C, Kasap Demir B, Tekindal MA, Erfidan G, Simsek OO, Arslansoyu Camlar S, Alparslan C, Alaygut D, Mutlubas F, Elmali F. Re-evaluating hypertension in children according to different guidelines: a single-center study. Hypertens Res 2022; 45:1047-1057. [PMID: 35365799 DOI: 10.1038/s41440-022-00896-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
We aimed to evaluate the agreements 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). Thresholds proposed by the Fourth Report (FR), European Society of Hypertension (ESH), and American Academy of Pediatrics (AAP) for OBP and the Wühl, ESH, and American Heart Association (AHA) for ABPM were used, and nine different BP phenotype combinations were created. The agreements between the thresholds, the sensitivity of the thresholds, and the BP phenotypes used to predict LVH were determined in 949 patients with different ages and body mass indices (BMIs). The agreements between the 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 into BP phenotypes, we obtained nine different combinations, which had "very good" agreement (κ = 0.880; 95% CI, 0.879-0.880). The sensitivity of AAP for detecting LVH was the highest in <12-year-old obese children (S = 75.8, 95% CI, 56.4-89.7). The sensitivity of ABPM in detecting LVH was similar among different age and BMI groups. The sensitivity of different BP phenotypes tended to be higher in the groups where OBP was evaluated according to AAP. The highest sensitivity was detected in the 13- to 15-year-old normal weight group.(S: 88.8, 95% CI, 51.7-99.7). The AAP guideline is more sensitive and decisive for BP phenotypes to detect LVH, especially in normal-weight children ≤ 15 years, while ABPM thresholds for children have limited effect.
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Affiliation(s)
- Cemaliye Basaran
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey.
| | - Belde Kasap Demir
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey.,Faculty of Medicine, Department of Pediatrics, Division of Nephrology & Rheumatology, Izmir Katip Celebi University, İzmir, Turkey
| | - Mustafa Agah Tekindal
- Department of Biostatistics, Faculty of Medicine, Izmir Katip Celebi University, İzmir, Turkey
| | - Gokcen Erfidan
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ozgur Ozdemir Simsek
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Secil Arslansoyu Camlar
- İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, University Health Sciences, İzmir, Turkey
| | - Caner Alparslan
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Demet Alaygut
- İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, University Health Sciences, İzmir, Turkey
| | - Fatma Mutlubas
- İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, University Health Sciences, İzmir, Turkey
| | - Ferhan Elmali
- Department of Biostatistics, Faculty of Medicine, Izmir Katip Celebi University, İzmir, Turkey
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