Abstract P055: Evaluating the Impact of the New Pediatric Clinical Practice Guideline on the Prevalence of Pediatric Hypertension and Associations With Adult Hypertension: The International Childhood Cardiovascular Cohort (i3C) Consortium

Background: New pediatric hypertension (HTN) definitions were recently introduced in a clinical practice guideline (CPG). We evaluated the impact of the CPG (compared to the previous guideline, the “Fourth Report”) on the prevalence of pediatric HTN and associations with HTN in adulthood. Methods: Data from the International Childhood Cardiovascular Cohort (i3C), a consortium comprising seven large, long-standing study cohorts from the United States, Finland, and Australia, were used. The mean of 2-6 BP measurements using an auscultatory technique were obtained. BP was categorized as normal, elevated, and hypertensive (stage 1 and 2) using the Fourth Report and CPG. For those with multiple BP assessments within an age category, a random assessment was selected for analysis. Childhood participants were contacted in adulthood and data on self-reported HTN was recorded. Results: There were 34,014 youth (mean age 10.4 ± 3.1 years, 49.4% male) with 92,751 BP assessments available for analysis. Use of the CPG increased hypertension prevalence from 7.6% to 13.5% (stage 1) and 1.3% to 2.5% (stage 2, p <0.0001). Among those 6 to <9 years, 805/880 (91.5%) re-classified from elevated BP to stage 1 HTN (Table). The greatest reclassification from stage 1 to 2 HTN occurred among those aged 15 to <18 years (294/597, 31.3%). The greatest reclassification to a lower BP category occurred among youth measured at age 13 to <15 years. Of 9,591 adults (mean age 48.8 +/- 7.9 years, range 21.0 - 64.6 years), 2,913 (30.4%) had self-reported HTN. The sensitivity for predicting adult HTN among those with HTN at any point in childhood was 13.4% and 22.4% (specificity 92.3% and 85.9%), as defined by the Fourth Report and CPG, respectively. Conclusion: The CPG resulted in a significantly increased prevalence of HTN in children and adolescents due to significant re-classification to higher BP categories. While the observed increases were not consistent across age groups, the results suggest increased sensitivity regarding the development of HTN in adulthood.