Abstract 603: Clinic Blood Pressure Prediction of Normal Ambulatory Blood Pressure in Youth
INTRODUCTION: As obesity in youth has increased over time, elevated blood pressure (BP) has also risen. Ambulatory Blood Pressure Monitors (ABPM) may be useful since younger patients have low pretest probability of hypertension and are susceptible to both white-coat and masked hypertension. To aid in appropriate ABPM use within a referral cohort, we sought to define systolic clinic BP (CBP) that predicted normal ABPM and target end organ damage (TOD).
METHODS: Data were collected on consecutive patients referred for high BP undergoing ABPM from 2010-13 (n=253, 33.3% female, mean age 15.9 ± 3.7 years). Logistic regression models adjusted for age, sex, and height were used to determine the relation between normal ABPM as the outcome and CBP indices, which were sequentially replaced as predictor. CBP indices were defined as systolic maximum, minimum or average auscultative, automated or combined. Relations between TOD and CBP or ABPM were assessed using logistic regression. Receiver operator curves tested the predictive utility of significant CBP indices.
RESULTS: Lower in-clinic auscultative CBP predicted Normal BP [Table1] and had a c-statistic of 0.61. Auscultative CBP at the 95% threshold had sensitivity of 71%, specificity of 47%, positive predictive value of 58%, and negative predictive value of 61% for normal ABPM. Auscultative maximum CBP did not predict elevated left ventricular mass:volume ratio (OR 1.03 [0.98-1.09]; p=0.23) while ABPM hypertension did (3.44 [1.28-9.24]; p=0.01)
CONCLUSION: In youth, auscultative CBP was a weak predictor of normal ABPM and did not predict end organ damage. The role of ABPM in general and special populations deserves exploration.
Author Disclosures: P.K. Johnson: None. M.A. Ferguson: None. J.P. Zachariah: B. Research Grant (includes principal investigator, collaborator, or consultant and pending grants as well as grants already received); Significant; NIH/National Heart and Lung Blood Instituet grant K23 HL111335-O1A1.
- © 2014 by American Heart Association, Inc.