Children with CKD more likely to be identified as hypertensive with 2017 guidelines
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Based on both clinic and ambulatory blood pressure, children with chronic kidney disease are more likely to be grouped as hypertensive when using the American Academy of Pediatrics 2017 clinical practice guidelines vs. its 2004 guidelines.
According to data published in the American Journal of Kidney Diseases, the 2017 guidelines better discriminate patients with higher levels of proteinuria.
“In 2017, the American Academy of Pediatrics (AAP) released an updated clinical practice guideline (CPG) for evaluation and management of hypertension in children and adolescents. The AAP CPG includes new normative [blood pressure] BP values based upon blood pressure measurements restricted to those obtained in children of normal body weight, and revised the classification system for childhood hypertension, including adoption of adult hypertension thresholds for adolescents aged at least 13 years of age,” Derek K. Ng, PhD, assistant professor of department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote.
In an observational cohort study, researchers examined 1,041 pediatric patients with CKD from the CKD in Children study to measure the impact of new BP guidelines. Mean follow-up was 4.5 years with an average of 6.1 person-visits.
Researchers compared the BP measurements using the 2004 Fourth Report normative data and definitions vs. the updated guidelines in 2017. With BP as the exposure, researchers considered the BP percentiles and hypertension stages determined by each guideline as the primary outcome. Researchers conducted agreement analyses to compare the estimated percentile and prevalence of high BP based on the 2017 and 2004 guidelines to clinic and combined ambulatory BP readings.
Although the ratio of patients classified with normal clinic BP was similar using the 2017 and 2004 guidelines, the 2017 normative data classified 22% patients as having hypertensive-range BP with marginal reproducibility vs. 11% using the 2004 guidelines. Further, those classified as hypertensive by the 2017 guidelines had higher levels of proteinuria compared with those classified by the 2004 guidelines.
“The differences in BP classification presented in this analysis should be carefully considered as clinicians track and understand longitudinal BP control for individual patients. We recommend re-calculating previous BP percentiles using the 2017 CPG and basing treatment decisions on the reclassified BP stages,” Ng and colleagues wrote. “Clinicians should be aware that whereas re-calculating percentiles will yield more hypertension and higher BP percentiles in their patient population overall, this may not be true for individual patients given some subtle differences seen in the general pediatric population based on sex and age.”
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