Ambulatory Blood Pressure Monitoring in Adults with Congenital Heart Disease

Background/Objectives: Adults with congenital heart disease (ACHD) are at high risk for late cardiac sequelae and hypertension (HTN). Ambulatory blood pressure monitoring (ABPM) is superior to office measurements in reproducibility, association with cardiovascular outcomes, and detection of masked and white coat HTN (WCH). The utility of ABPM in the ACHD population is not well studied. This study aims to determine the prevalence of hypertension in the ACHD population and evaluate the utility of ABPM in diagnosing hypertension in the ACHD population. Methods: This is a single-center retrospective analysis of ACHD patients who completed ABPM from 2021 to 2024. Results: Forty ACHD patients underwent ABPM during the study period. Twenty-nine (73%) had hypertension (HTN) in clinic. On ABPM, nine (23%) were confirmed normotensive, 15 (38%) had white coat hypertension (WCH), 14 (35%) were confirmed hypertensive, and two (5%) had masked HTN. There was a 33% decrease in patients meeting criteria for HTN on ABPM compared to in clinic (p = 0.002). Ten patients with HTN on ABPM had follow-up, during which seven (70%) had improved clinic blood pressure. One patient (2.5%) had an antihypertensive removed following WCH diagnosis on ABPM. Conclusions: ABPM is a useful way to diagnose and monitor hypertension in the ACHD population. Based on ABPM, many patients (43%) were found to have either WCH or masked HTN, and 15% had their HTN stage reclassified. ABPM results led to 33% of patients having subsequent medication adjustment. Data from ABPM can help optimize medical management, in turn reducing cardiac strain and acquired heart disease risk in ACHD patients.