Abstract 19065: Clinical Innovation

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Abstract

Introduction: Pediatric hypertension (HTN) is a growing problem but continues to be underdiagnosed and undertreated. The divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to 1) screen children at risk for HTN, 2) assess cardiovascular health status, and 3) optimize medical management. We present our findings of this unique population since initiation of this innovative program.

Methods: Data was collected from all initial patient visits to the Hypertension and Vascular Evaluation (HAVE) program at the Children's Hospital of Philadelphia between 12/2011 and 12/2015. Demographic, nutrition, activity level, clinical and diagnostic data were evaluated using descriptive statistics.

Results: There were 242 patients referred to the HAVE program, including those with morbid obesity and/or primary hypertension (26%), solid organ transplants (25%), diabetes (12%), renal artery stenosis (10%), and aortic coarctation (8%). The average age was 14.5±4.2 years. Fifty-two percent were white and 57% male. Sixty-seven percent of patients were on anti-hypertensive medication at the time of visit. Of the 81 untreated patients, 49% had evidence of HTN on 24-hour ambulatory blood pressure monitoring (ABPM). About half of patients with a normal clinic blood pressure had HTN on ABPM. Over half of the patients were overweight (51%), with the majority being over the 95th percentile for body mass index. Most patients (83%) ate < 5 servings of fruits and vegetables and 40% reported no regular exercise. Only 53% of patients over 11 years of age had a lipid screening, which is recommended for all children between 9 and 11 years of age . Changes in anti-hypertensive medication or further testing were recommended for 73% of patients and 90% were counseled regarding healthy lifestyle.

Conclusions: Our initial experience suggests that a multi-disciplinary program dedicated to pediatric HTN facilitates early diagnosis in high-risk populations and optimization of medical management. ABPM identifies HTN in patients with normal clinic blood pressure. Further investigation into patient characteristics and subclinical end organ changes may lead to targeted therapy to improve cardiovascular health into adulthood.

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