60 - Association of blood pressure severity, target organ injury, and cardiovascular health with pharmacologic treatment and nutritional referral at baseline: A SUPERHERO Registry analysis

Poster Number: 60
Publication Number: 60.1857

Background: The prevalence of youth-onset hypertension (HTN) is rising in concert with increased obesity prevalence and cardiovascular risk factors. Pharmacological treatment and lifestyle management via nutrition referral are management strategies for HTN. Pharmacological treatment is recommended with more severe HTN and worsened cardiovascular (CV) health status; however, it remains unknown if this occurs in youth.

Objective: Determine if there are differences in initial management of HTN disorders in youth based on degree of blood pressure (BP) severity, target organ injury, and cardiovascular health.

Design/Methods: Cross-sectional analysis of baseline data from the Study of the Epidemiology of Pediatric HTN (SUPERHERO) Registry, a multisite retrospective registry of youth referred to subspecialty care for HTN disorders using electronic health record data validated with manual record review . Inclusion criteria were an initial subspecialty clinic visit for HTN disorders identified by ICD-10 codes from 1/1/2016–12/31/2022 and age < 19 years. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. Exposures included BP with z-scores and classification per US guidelines, obesity by BMI or weight-for-length percentiles, and dyslipidemia, hyperglycemia, and TOI by ICD-10 codes. The outcomes were orders placed for nutrition referral and prescription of antihypertensive medication. We estimated the associations with adjusted generalized linear models.

Results: Of the 10,968 subjects, mean age was 12.5 ±4.7, 38% were female, 58% (n=6311) had obesity, 24% (n=2617) had stage 2 HTN, 5% (n=596) had TOI, 7% (n=754) had dyslipidemia, and 8% (n=881) had hyperglycemia, and 7% (n=715) had nutrition referral. Subjects with stage 2 HTN, TOI, and two CV risk factors were more likely to be prescribed antihypertensive medication. Subjects with obesity, dyslipidemia, and two CV risk factors were more likely to be referred to a dietitian while participants with obesity and worsening CV health were referred for weight management independent of BP severity or TOI.

Conclusion(s): In a large multisite cohort of youth referred for HTN disorders, participants with more severe HTN and worsened CV health are more likely to receive pharmacological treatment. We identified important gaps in care including 7% of participants receiving referral to nutrition despite the role of weight management in HTN disorders. Future studies will investigate the role of health care disparities in these treatment gaps which can be used to inform future management of youth with HTN disorders.