IMPACT OF NEW AHA STATEMENT OF ABPM IN DIAGNOSIS OF HYPERTENSION IN OBESE CHILDREN

Introduction:

Global prevalence of hypertension and obesity is increasing rapidly for the past decades. Ambulatory blood pressure monitoring (ABPM) is a crucial tool for diagnosing and managing hypertension in children, sidestepping the pitfalls of office blood pressure measurements. 24 hr ABPM evaluation in high-risk children can identify the masked hypertension (MH) and provide an opportunity for early detection and management of hypertension. There is a paucity of research on diagnosis of hypertension and hypertension induced end organ damage by 2022AHA -ABPM guidelines as compared with  2014 AHA-  ABPM guidelines 

Methods:

Objectives:

1.Compare the performance of 2014 and 2022 AHA guideline on ABPM in diagnosing hypertension in obese children

2.To compare the performance of two guidelines in predicting end organ damage

       Materials and methods:

Post hoc analysis of a single centre prospective study on children in the age group of 5-18 yr with obesity who underwent ABPM from 2019- 2021.Children diagnosed with prehypertension, severe ambulatory hypertension or unclassified by 2014 AHA guideline were reclassified by 2022 AHA guidelines. All participants were screened for end-organ damage in terms of carotid intimal medial thickness (cIMT) and Left Ventricular Mass Index (LVMI) using Echocardiography.

Results:

Among 60 children, 26 (43.3%) participants were found to be hypertensive based on ABPM evaluation.24 Hr ABPM analysis using 2024 result in 11.6% participant in unclassified category and raises clinical dilemma (figure 1) for further management. Five out of 7 unclassified children were reclassified as normotensive and other two children were reclassified as WCH (Figure 2). Prevalence of MH remains the same. There is no significant clinical, demographic variable es associated with reclassification category. Cohen's kappa for agreement of diagnosis of hypertension by both 2014 and 2022 ABPM guidelines is 0. 843.End organ damage was detected in 16 (26.7%) children. Prevalence of end organ damage remains same in both 2014 and 2022 ABPM guidelines.

Conclusions:

The recent 2022 AHA statement on ABPM simplify the interpretation compared to complex earlier 2014 statement. Eliminating the of BP load   and addition of specific ABPM cut off for adolescent help to reclassify the paediatric population. All unclassified were assigned a diagnostic phenotype with the implementation of the 2022 guidelines. The recent 2022 AHA statement -simplification of ABPM interpretation criteria through the removal of blood pressure loads.2022 AHA guideline had a good agreement with 2014 AHA guideline in identifying hypertension. Limited size of the study is a limitation owing to the feasibility and logistics constructs and this might have resulted in less power of the estimated effects.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.