79 - Baseline blood pressure severity and initial management of pediatric hypertension: A SUPERHERO interim analysis

Poster Number: 79
Publication Number: 79.324

Jack Weaver, Levine Children's Hospital, Charlotte, NC, United States; Victoria Giammattei, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Caroline B. Lucas, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Blanche White, Atrium Health, Matthews, NC, United States; Susan Odum, Atrium Health, Charlotte, NC, United States; Andrew M. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: The extent to which providers adhere to the 2017 Clinical Practice Guideline for management of hypertension (HTN) in children is unclear.  The Study of The Epidemiology of Pediatric Hypertension (SUPERHERO) Registry, an ongoing multicenter retrospective cohort study of youth referred to subspecialty care for hypertensive disorders, is investigating this question.

Objective: Determine if severity of baseline blood pressure is associated with initiation of pharmacologic therapy or evaluation for target organ damage (TOD) by echocardiogram (echo) and urine protein or albumin orders.

Design/Methods: In this interim analysis of baseline data from Phase 1.1, data from the index visit to a HTN clinic was obtained via data queries to the electronic health record and data warehouse at Brenner Children’s and Atrium Health Levine Children’s. Inclusion criteria were an initial visit for hypertensive disorder by ICD-10 code between 1/1/2016 to 6/30/2021 and age 2 to 18. Exclusion criteria were kidney failure on dialysis, kidney transplantation, and active pregnancy by ICD-10 code.  Our exposures were baseline average blood pressure (absolute values for age > 13 years, z-scores for age < 13 years) and blood pressure classification.  Our outcomes were antihypertensive medication, echo, and urine protein or albumin orders.  Across-group trends were analyzed using linear regression, Cochran-Armitage test, Cochran-Mantel-Haenszel test, and Jonckheere-Terpstra test.

Results: For this analysis of 2537 participants, median age was 14.3 years [11,1, 16.4], 62.5% were male, 28.4% were Black, 18.1% were Hispanic/Latino, 49.2% were White, and 58.7% had obesity.  Blood pressure severity included elevated blood pressure 17.2%, stage 1 HTN 35.5%, and stage 2 HTN 27.3%.  Patients with more severe HTN were more likely to be older, male, and have obesity (p < 0.05). Echos were ordered in 47.5 % of patients, urine studies were ordered in 72.3% of patients, and  pharmacologic therapy in 21.5 %.  Participants with more severe HTN were more likely to have echos and anti-hypertensive medication prescriptions but less likely to  have urine studies ordered (Table 3).Conclusion(s): In a large multicenter cohort of youth referred for subspecialty evaluation of hypertensive disorders, patients with more severe blood pressure were more likely to be prescribed antihypertensive medication and have an echo ordered, but were less likely to be evaluated for albuminuria or proteinuria.  Ongoing steps include multivariable analysis to continue to investigate management trends in youth with hypertensive disorders
Baseline demographic and clinical characteristics of youth referred for hypertensive disorders by blood pressure severityN (%), Mean (SD), median [IQR]. *trend p < 0.05 by Cochran-Armitage trend test, Cochran-Mantel-Haenszel test, or linear regression. BP, blood pressure; DBP diastolic BP, HTN, hypertension; SBP, systolic blood pressure
Target organ damage tests orders and anti-hypertensive medication prescription at baseline in youth referred for hypertensive disorders by blood pressure severityN (%), Mean (SD), median [IQR]. *trend p < 0.05 by Cochran-Armitage trend test, Cochran-Mantel-Haenszel test, or linear regression. BP, blood pressure; DBP diastolic BP, HTN, hypertension; SBP, systolic blood pressure