Abstract 14654: The Relative Roles of Clinic Blood Pressure and Ambulatory Blood Pressure Monitoring in Evaluating Pediatric Hypertension: Dollars and Sense
Background: The Affordable Care Act of 2010 mandates population-wide identification of high blood pressure (BP) in children. Given children are prone to white-coat and masked hypertension, inappropriate or inadequate therapy is possible. As screening increases, confirmatory ambulatory blood pressure monitoring (ABPM) utilization may increase which could then increase costs. In our referral cohort, we sought clinic BP (CBP) combinations that predicted ABPM hypertension and to model the cost-efficiency of BP diagnostic strategies.
Methods: Clinical and BP data were collected from a consecutive cohort of children referred for elevated BP with a complete ABPM from 2010-2012 (n=170, females= 58, mean age 15.6±3.7 years). Linear regression models were built with ABPM mean 24 hour systolic BP (SBP) or SBP load as continuous outcomes. Holding age, sex, height, and clinic heart rate as covariates in each model, various CBP indices were sequentially replaced as the predictor of interest. Next, significant indices were sequentially placed into a logistic regression model with ABPM hypertension (mean 24 hour SBP> 95% and SBP load >25%) as the outcome. Within a nested subsample, we compared accuracy and total charges in 3 diagnostic models based on linear regression
Results: 1. Auscultative CBP >95% alone; 2. ABPM to confirm CBP >90%; or 3. ABPM alone.
Results: Several CBP indices predicted SBP mean [Table 1]. However, none predicted ABPM hypertension. CBP alone, CBP+ABPM, or ABPM alone identified 40%, 70%, or 100% of hypertensive cases and accrued charges of $28,368, $11,375, or $11,336 per case identified, respectively.
Conclusion: CBP indices did predict ABPM mean SBP, but none predicted ABPM hypertension, suggesting ABPM may be needed for all children referred for elevated BP. ABPM alone was most accurate and efficient, due to false positives and negatives with other strategies. Future work may determine ABPM utility in larger cohorts and in primary care settings.
- © 2013 by American Heart Association, Inc.