Abstract 15624: The Impact of One versus Three Readings on Pediatric Hypertension Diagnosis is Mediated via Diastolic Blood Pressure

Abstract

Introduction: Blood pressure (BP) is affected by many factors. In pre-teen children, the hypertension (HTN) threshold is about 4 mmHg higher for systolic and about 3 mmHg for diastolic BP. Single BP reading is the norm in real life clinical practice even as HTN guidelines and research use multiple BP readings. There is limited data on the within-visit BP variability in children. The National Health and Nutrition Examination Survey (NHANES) is a population-based survey and 3 BP readings are obtained using a standardized protocol. We aimed to study the difference between single versus 3 BP readings using NHANES data. Methods: In the 2017-2018 NHANES, participants aged 8 years and older underwent BP measurement using 2 protocols. The auscultation protocol (AP) was administered by a physician using a mercury sphygmomanometer. The oscillometric protocol (OP) was administered by a health technician using an Omron HEM-907 XL device. We included participants 8 to 17 years old with 3 AP and 3 OP BP readings for comparison and excluded those with DBP of zero. Results: There were 1126 subjects who met inclusion criteria. The proportion of SBP readings with a difference of at least 5 mmHg between the initial and subsequent 2 BP readings was greater with OP but greater with AP for DBP (Table 2). Similar trend was noted with comparison of initial and mean of all 3 BP readings. Coefficient of variation was higher for DBP than SBP. The proportion of patients with hypertension range BP was significantly higher for DBP than for SBP (table 3). Conclusions: Diastolic BP shows more variability with multiple measurements. Hypertension range BP was noted more often with the initial DBP measurement than with 3 BP readings.