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Impact of the 2022 American Heart Association pediatric ambulatory blood pressure monitoring statement on the diagnosis of hypertension

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Abstract

Background

The diagnosis of hypertension and hypertension-induced target organ injury by the 2022 American Heart Association (AHA) ambulatory blood pressure threshold as compared with 2014 AHA and 2016 European Society of Hypertension (ESH) thresholds has not been evaluated.

Methods

In a cross-sectional study (n = 291, aged 5–18 years, at a tertiary care outpatient clinic), we compared 2022 AHA with 2014 AHA and ESH thresholds (revised with 2018 adult ESH thresholds where applicable) to diagnose ambulatory hypertension (AH), and detect ambulatory arterial stiffness index (AASI) and left ventricular target organ injury (LVTOI).

Results

The 2022 AHA threshold diagnosed significantly more AH (53%) than the 2014 AHA (42%, p < 0.01) and ESH (36%, p < 0.001) thresholds. The 2022 AHA threshold demonstrated only a moderate agreement with the 2014 AHA (kappa (k) = 0.77) and ESH (k = 0.66) thresholds to diagnose AH. Adjusted logistic regression analysis found that only the 2022 AHA threshold predicted elevated AASI significantly (odds ratio 2.40, 95% CI 1.09, 5.25, p = 0.02; AUC 0.61, p < 0.01). In those with elevated AASI, more participants had AH by the 2022 AHA threshold (72%) than the 2014 AHA (46%, p = 0.02) and ESH (48%, p = 0.03) thresholds. AH defined by the 2022 AHA threshold continued to maintain higher odds, larger AUC, and higher sensitivity to identify LVTOI than the 2014 AHA and ESH thresholds; however, the difference did not reach a statistically significant level.

Conclusions

AH defined by the 2022 AHA threshold diagnoses more children with hypertension and identifies more children with hypertension-induced target organ injury than the 2014 AHA and ESH thresholds.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [APS], upon reasonable request.

Abbreviations

OBP:

Office blood pressure

ABP:

Ambulatory blood pressure

ABPM:

Ambulatory blood pressure monitoring

AHA:

American Society of Hypertension

ESH:

European Society of Hypertension

MH:

Masked hypertension

WCH:

White coat hypertension

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Acknowledgements

We are grateful to Carlos Rees, RN, for a diligent organization of 24-h ambulatory blood pressure monitoring for our patients.

Funding

The research was supported by a grant from the Academic Medical Organization of Southwestern Ontario (AMOSO) and a Summer Student Grant.

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Authors and Affiliations

  1. University of Western Ontario, London, ON, Canada

    Ajay P. Sharma, Amrit Kirpalani, Ajaya Sharma, Luis Altamirano-Diaz, Guido Filler & Kambiz Norozi

  2. Division of Nephrology, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A5W9, Canada

    Ajay P. Sharma, Amrit Kirpalani & Guido Filler

  3. Division of Cardiology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada

    Luis Altamirano-Diaz & Kambiz Norozi

  4. Department of Pediatric Cardiology and Intensive Care, Medical School, Hannover, Germany

    Kambiz Norozi

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Sharma, A.P., Kirpalani, A., Sharma, A. et al. Impact of the 2022 American Heart Association pediatric ambulatory blood pressure monitoring statement on the diagnosis of hypertension. Pediatr Nephrol 38, 2741–2751 (2023). https://doi.org/10.1007/s00467-022-05856-z

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