Comparison of Pediatric and Adult Ambulatory Blood Pressure Monitoring Criteria for the Diagnosis of Hypertension and Detection of Left Ventricular Hypertrophy in Adolescents.
OBJECTIVE:To compare pediatric ambulatory blood pressure monitoring (ABPM) criteria with adult ABPM criteria for the diagnosis of hypertension and detection of left ventricular hypertrophy (LVH) in adolescents STUDY DESIGN: ABPM and echocardiography reports from adolescents age 13-21 from 2015-2019 were analyzed. The concordance of hypertension based on pediatric criteria (AHA 2014) was compared with adult criteria from ACC/AHA 2017 (overall BP>125/75mmHg, wake BP>130/80mmHg, sleep BP>110/65mmHg) using the Cohen kappa statistic. Logistic regression, adjusted for body mass index z-score, and receiver operating characteristic curves (ROC) compared pediatric criteria versus adult criteria in predicting LVH (left ventricular mass index [LVMI]>95th%ile reference values and LVMI>51g/m2.7) RESULTS: Of 306 adolescents, 140 (45.8%) had hypertension based on pediatric criteria versus 228 (74.5%) based on adult criteria; the agreement was poor (59.3%, N=137, kappa=0.41). A higher prevalence of LVH was captured by adult criteria only (N=91) compared with pediatric criteria only (N=3). Logistic regression found no significant differences between pediatric and adult criteria in the detection of LVH>95th%ile (OR 1.24, CI: 0.66,2.31, p=0.51) or >51g/m2.7 (OR 1.06, CI: 0.47,2.40, p=0.89). ROCs for pediatric criteria were not significant for detecting LVH>95th%ile (0.50, p=0.91) or >51g/m2.7 (0.55, p=0.45), whereas the ROC for adult criteria was significant for detecting LVH>95th%ile (0.59, P = .045) but not >51g/m2.7 (0.63, p=0.07). Although all individuals with LVH>51g/m2.7 were hypertensive by adult criteria, 8 of these individuals were missed by pediatric criteria CONCLUSION: Adult criteria captured a higher prevalence of LVH and appears to better predict LVH than pediatric criteria. A consideration to align ABPM criteria for diagnosing hypertension in adolescents with adult guidelines is warranted.
School of Medicine