6277 Updating ambulatory blood pressure monitoring reporting guidelines in a tertiary paediatric UK hospital: a comparison

Objectives Our paediatric nephrology department, until recently, used the 2012 American Heart Association (AHA)¹ guidelines for reporting of ambulatory blood pressure monitoring (ABPM). The two newer guidelines available are the 2022 AHA² and the 2016 European Society of Hypertension (ESH)³ guidelines. The 2022 AHA guidelines include revised blood pressure centiles that incorporate static cut points for adolescents ≥13 years that don't vary with height or age. The 2016 ESH guidelines are similar for adolescents ≥16 years. Our aim was to evaluate the incidence of hypertension diagnosis in paediatric patients who underwent ABPM using the two newer guidelines available. Methods This was a retrospective cohort study of all consecutive patients referred for ABPM to a tertiary paediatric hospital nephrology department between March and August 2023. ABPM recordings were done using Spacelabs-Healthcare (USA) OnTrak monitors. Seventy-two (n=72) patients were included in the study. Fifty-five (n=55) patients were included in the analysis, and 17 patients were excluded due to insufficient number of blood pressure recordings. The ABPM readings were assessed using all three guidelines. Results The median age of the 55 patients included in the analysis was 14.1 years (IQR 11.75, 15.0; range 7.0–18.0 yrs, 49% female). The median BMI was 21.2 kg/m² (IQR 18.3, 24.8). The median number of BP readings was 59 (IQR 50, 61). The background diagnoses for the patients were: Congenital anomalies of kidney and urinary tract (n=14), glomerular disease (n=5), cystic kidney disease (n=3), vasculitides (n=3), renovascular hypertension (n=3) and others (n= 27). Fifty-two percent (52%) of the patients were hypertensive according to the 2012 AHA and 2016 ESH guidelines. Using 2022 AHA guidelines, 60% patients were hypertensive [figure 1]. However, this difference was not statistically significant (p=0.68). A higher number of patients (44%) were diagnosed with hypertension based on elevated night systolic averages above the 95th centile with 2022 AHA guidelines, compared to 2012 AHA (22%) and 2016 ESH (20%) [figure 2]. Conclusion ABPM is recommended in paediatric patients with elevated BP and provides useful information in the diagnosis and management of paediatric hypertension. We found no difference in the incidence of hypertension diagnoses made in our study population when either of the three main guidelines were used. References Eoin O'Brien, Gianfranco Parati, George Stergiou, et al. 2013. Joseph T Flynn, Elaine M Urbina, Tammy M Brady, Carissa Baker-Smith, Stephen R Daniels, Laura L Hayma, et al. Hypertension 2022. Empar Lurbea, Enrico Agabiti-Rosei, J Kennedy Cruickshank, Anna Dominiczak, Serap Erdine, Asle Hirth, Cecilia Invitti, et al. Journal of Hypertension 2016.