Comparison of Pediatric and Adult Ambulatory Blood Pressure Monitoring Criteria for the Diagnosis of Hypertension and Detection of Left Ventricular Hypertrophy in Adolescents.

Publication Date


Journal Title

J Pediatr


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.

Volume Number




Document Type





School of Medicine

Primary Department

General Pediatrics





For the public and Northwell Health campuses