Using adult BP criteria may reclassify many adolescents as hypertensive
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The use of the updated American Heart Association 2022 ambulatory BP monitoring guideline reclassified many adolescents from normotensive to hypertensive, researchers reported.
An analysis of the updated guidance was published in Hypertension.
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“The recently published Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement from the American Heart Association provides new cut points for the diagnosis of hypertension using an ambulatory blood pressure monitor (ABPM) in those 13 years old and updates ABPM diagnostic criteria,” Shannon M. Lyon, DO, MSCR, attending physician in the department of cardiology at Boston Children’s Hospital and instructor of pediatrics at Harvard Medical School, and colleagues wrote. “The new cut points align with adult criteria and are generally lower than pediatric cut points published in 2014, particularly for adolescent males.”
Lyon and colleagues posited that the updated ambulatory BP monitoring criteria may cause more adolescents to be reclassified as hypertensive. They therefore evaluated the characteristics of reclassified adolescents and the impact of daytime compared with nocturnal hypertension.
This retrospective study included 310 ambulatory BP measurements obtained via brachial cuff from adolescents at Boston Children’s Hospital from 2015 to 2020 (mean age, 15 years; 72% male; 53% white; 41% with obesity). Each patient had at least 24 ambulatory BP measurements.
Each ambulatory BP measurement was categorized into one of three groups: group 1 was normotensive by both 2014 and 2022 criteria (14%); group 2 was normotensive by 2014 criteria and reclassified as by the 2022 criteria (40%); and group 3 was hypertensive by both 2014 and 2022 criteria (46%).
Lyon and colleagues observed no difference in age or BMI between the three groups; however, a greater proportion (83%) of group 2 were males, compared with groups 1 and 3 (P < .001).
Among adolescents who were reclassified by the 2022 criteria, 35% had both daytime and nocturnal hypertension; 3% had daytime hypertension alone; and 62% had nocturnal hypertension alone, according to the study.
The researchers observed no difference between groups 1, 2 and 3 in the prevalence of combined daytime and nocturnal hypertension or isolated daytime hypertension; however, nocturnal hypertension was more prevalent in group 2 compared with group 3 (P = .02).
“Although the prevalence of isolated nocturnal hypertension in the pediatric population has been described with use of higher pediatric BP thresholds, its prevalence in adolescents using lower adult BP cut points has not been reported,” the researchers wrote. “Further research is needed to better understand if adult cut points for nocturnal blood pressure are applicable to adolescents, the importance of nocturnal hypertension in children, and its relationship to long-term cardiovascular outcome measures.”
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