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Background: Younger age has been associated with unrecognized hypertension (HTN) in both the general pediatric population and in children on dialysis. An increased lifetime risk of cardiovascular disease and the association of HTN with chronic kidney disease (CKD) progression make optimal treatment of elevated blood pressure (BP) a key component of CKD management. However, the role of age in the recognition and treatment of HTN in non-dialysis pediatric CKD remains unknown.

Objective: Using data from the Chronic Kidney Disease in Children (CKiD) Cohort Study, we examined the relationship between age and recognized vs. unrecognized HTN, and the frequency with which stages I and II HTN are pharmacologically treated. Among children with unrecognized HTN, we also examined the relationship between age and rates of uncontrolled BP.

Design/Methods: Subjects included children <18 years of age with CKD stages 2-4, for whom BP measurements were available. Subjects were stratified by age (0 to <7 years, ≥7 to <13 years, ≥13 to ≤18 years) and BP readings were classified by percentile per AAP clinical guidelines. Unrecognized HTN was defined as HTN stage 1 or 2 based on clinic BP measurement without a self-reported diagnosis of HTN. Uncontrolled BP was determined by self-reported lack of antihypertensive treatment among those with HTN. Generalized estimating equations to account for repeated measures were applied to logistic regression analyses to evaluate the associations of age with unrecognized HTN and medication use.

Results: 890 CKiD Study participants with 3,442 annual study visits met inclusion criteria. Children <7 years of age had higher rates of stage 1 or 2 HTN and lower rates of antihypertensive use compared to older children (Table 1). 46% of children age <7 years with hypertensive BP readings had unrecognized, untreated HTN compared to 21% of hypertensive children >13 years of age. The youngest age group was associated with higher odds of unrecognized HTN (adjusted OR 2.03) and lower odds of taking antihypertensive medication (adjusted OR 0.48). With the exception of glomerular disease etiology of CKD, other covariates were not associated with unrecognized HTN.

Conclusion(s): Children with CKD younger than age 7 years are more likely to have both underdiagnosed and undertreated HTN compared to older children. Given the impact of hypertension on CKD progression and cardiovascular disease, efforts to improve BP control in these young children are needed.

Presented at the 2021 PAS Virtual Conference

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Nephrology | Pediatrics

When and Where Presented

Presented at the 2021 PAS Virtual Conference

The Association Between Age and Unrecognized and Untreated Hypertension in Children with Chronic Kidney Disease