Abstract：
OBJECTIVE: To describe the epidemiology of reclassification of prehypertensive and unclassified adolescents by 2022 American Heart Association pediatric ambulatory blood pressure monitoring (ABPM) guidelines, and to evaluate the association of the new diagnostic categories with left ventricular hypertrophy (LVH).
METHODS: A single-center, retrospective review of ABPM reports from adolescents 13-21 years old, from 2015 through 2022, was performed. Adolescents with prehypertension or unclassified by 2014 guidelines were reclassified by 2022 definitions. Logistic regression models evaluated the association of reclassification phenotypes with LVH.
RESULTS: A majority of prehypertensive adolescents reclassified to hypertension (70%, n = 49/70). More than one-half (57%, n = 28/49) of the hypertension was isolated nocturnal hypertension, and 80% was systolic hypertension. Reclassification to hypertension was more common in males. The majority (55.6%) of unclassified adolescents were reclassified to normotension. No demographic or clinical variables were associated with reclassification categories. LVH was not associated with hypertension in the reclassified prehypertensive or unclassified groups.
CONCLUSIONS: The 2022 ABPM guidelines clearly define blood pressure phenotypes. However, reclassification to hypertension was not associated with an increased odds of LVH. Because most prehypertensive adolescents reclassified as hypertensive by nighttime BPs alone, this study highlights the lowered threshold for nocturnal hypertension. Prospective studies in larger, well-defined cohorts are needed to describe better the predictive value of 2022 BP phenotypes for target organ damage.
METHODS: A single-center, retrospective review of ABPM reports from adolescents 13-21 years old, from 2015 through 2022, was performed. Adolescents with prehypertension or unclassified by 2014 guidelines were reclassified by 2022 definitions. Logistic regression models evaluated the association of reclassification phenotypes with LVH.
RESULTS: A majority of prehypertensive adolescents reclassified to hypertension (70%, n = 49/70). More than one-half (57%, n = 28/49) of the hypertension was isolated nocturnal hypertension, and 80% was systolic hypertension. Reclassification to hypertension was more common in males. The majority (55.6%) of unclassified adolescents were reclassified to normotension. No demographic or clinical variables were associated with reclassification categories. LVH was not associated with hypertension in the reclassified prehypertensive or unclassified groups.
CONCLUSIONS: The 2022 ABPM guidelines clearly define blood pressure phenotypes. However, reclassification to hypertension was not associated with an increased odds of LVH. Because most prehypertensive adolescents reclassified as hypertensive by nighttime BPs alone, this study highlights the lowered threshold for nocturnal hypertension. Prospective studies in larger, well-defined cohorts are needed to describe better the predictive value of 2022 BP phenotypes for target organ damage.
摘要：
目的通过2022年美国心脏协会（AHA）儿科动态血压监测（ABPM）指南，描述高血压前期和未分类青少年重新分类的流行病学。并评估新诊断类别与左心室肥厚（LVH）的关联。研究设计单中心，回顾性回顾13-21岁青少年的ABPM报告，从2015年到2022年，执行。根据2022年的定义，对患有高血压前期或根据2014年指南未分类的青少年进行了重新分类。Logistic回归模型评估了重新分类表型与LVH的关联。结果大多数高血压前期青少年重新分类为高血压(70%，N=49/70）。超过一半（57%，N=28/49）的高血压是孤立的夜间高血压，80%是收缩期高血压.在男性中，重新分类为高血压更为常见。大多数（55.6％）未分类的青少年被重新分类为正常。没有人口统计学或临床变量与重新分类类别相关。在重新分类的高血压前期或未分类组中，LVH与高血压无关。结论2022年ABPM指南明确定义了BP表型。然而,重新分类为高血压与LVH的几率增加无关.由于大多数高血压前期青少年仅通过夜间血压重新分类为高血压，这项研究强调了夜间高血压的阈值降低。更大的前瞻性研究，需要明确的队列来更好地描述2022年BP表型对靶器官损伤的预测价值.
