Abstract 5: White Coat Hypertension Stability In Children And Adolescents: Pediatric Nephrology Research Consortium Study

Abstract

There is no pediatric data on whether white coat hypertension (WCH) is a precursor of sustained HTN. The objective of this study was to determine diagnosis changes on follow-up ambulatory blood pressure monitoring (ABPM) in children and adolescents diagnosed with WCH on their initial ABPM and to assess for predictive factors of progression to HTN. Retrospective review was conducted at 11 centers to identify patients with WCH diagnosed by ABPM and had repeat ABPM at least 6 months after the first study. Subjects with secondary HTN, on antihypertensive medication, and diabetes mellitus were excluded. Patients with ADHD were included in the study if medications were stable. Chart review included associated risk factors such as BMI, obstructive sleep apnea, and family history of HTN. ABPM phenotype was determined using the 2014 AHA guidelines. The association between abnormal ABPM diagnosis on follow-up and ABPM index and blood pressure load variables was assessed using univariable generalized linear mixed effect models. Significant ABPM index and load variables (based on p < 0.15) were subsequently added to a multivariable model with the following pre-specified covariates: gender, family history of HTN, age, BMI z-score, ADHD, and interval time between ABPMs. One hundred and one patients met criteria for inclusion with a median age of 14 years (80% males) and median interval time of 14 months (range: 6 – 55 months). On follow-up ABPM, 18% and 32% of patients demonstrated HTN and prehypertension respectively (18 and 32 of 101, respectively). In univariable modeling, awake and nocturnal systolic BP index ≥ 0.9 on the first ABPM were found to be significantly associated with progression to abnormal ABPM [unadjusted OR (95% CI) awake: 4.3 (1.2 – 14.6); nocturnal: 3.2 (1.0 – 10.1)]; however, these associations were not significant after adjusting for pre-specified covariates [adjusted OR (95% CI) awake: 2.7 (0.7-10.4); nocturnal: 2.6 (0.7 – 9.2)]. Approximately half of children and adolescents first diagnosed with WCH progressed to an abnormal ABPM phenotype on follow-up, suggesting that longitudinal follow-up with ABPM is indicated in pediatric WCH patients. We were unable to identify ABPM findings that might predict a higher risk for progression.