ESPE2019 Free Communications Diabetes and Insulin Session 2 (6 abstracts)
2017 American Academy of Pediatrics Clinical Practice Guideline: Impact on Prevalence of Arterial Hypertension in Children and Adolescents with Type 1 Diabetes mellitus
Axel Dost 1 , Susanne Bechtold 2 , Katharina Fink 3,4 , Walter Bonfig 5 , Dagobert Wiemann 6 , Thomas Michael Kapellen 7 , Michael Witsch 8 , Karl Otfried Schwab 9 & Reinhard Walter Holl 3,4
1Department of Pediatrics, University Hospital Jena, Jena, Germany. 2Department of Pediatric Endocrinology/Diabetology, Ludwig-Maximilians-University Munich, Munich, Germany. 3Institute of Epidemiology and Medical Biometry, ZIMBT, University of Ulm, Ulm, Germany. 4German Center for Diabetes Research (DZD), Munich, Munich, Germany. 5Department of Pediatrics, Hospital Wels-Grieskirchen, Wels, Austria. 6Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany. 7Department of Pediatrics, University Hospital Leipzig, Leipzig, Germany. 8Department of Pediatrics, Centre Hospitalier de Luxembourg, Luxemburg, Luxembourg. 9Department of Pediatrics, University Hospital Freiburg, Freiburg, Germany
Background: In 2017 the American Academy of Pediatrics has introduced a new guideline (AAP 2017) to diagnose arterial hypertension in children, as the blood pressure thresholds for adults had been lowered before. There is a controversy about these new reference levels as other societies have not followed these recommendations. We studied the impact of the new AAP 2017 guideline on prevalence of arterial hypertension (HTN) in children with Type 1 diabetes mellitus (T1DM).
Methods: Up to September 2018, 1.4 million office BP measurements of 79849 children and adolescents (aged 5-20 years) with T1DM have been documented in the DPV registry. BP values of the most recent year were aggregated, BP of 74677 patients without antihypertensive medication were analyzed (median age 16 yrs., diabetes duration 5.3 yrs., 52.8% boys). BP values were classified according to AAP 2017, the references of the German KIGGS (2011) and the 4th report (2004).
Results: 44.1%, 29.5% and 26.5% of the patients were hypertensive according to AAP 2017, KIGGS and 4th report, resp. Differences in prevalence of HTN were strongly age depended: <10 years: AAP 2017 31.4%, KIGGS 30.7%, 4th report 19.6%, 10-<15 years: AAP 2017 30.9%, KIGGS 31.2%, 4th report 22.4% and ≥15 years AAP 2017 53.2%, KIGGS 28.4%, 4th report 30.0%. Among teenagers ≥15 years, 59.1% of the boys but only 46.3% of the girls were classified as hypertensive by AAP 2017 but based on KIGGS/4th report only 21.1%/26% of the boys and 36.7%/34.4% of the girls, resp.
Conclusion: Classification of BP as hypertensive depends strongly on the references. AAP 2017 results in a significant increase HTN in teenagers ≥13 years with T1DM, particularly in boys. AAP 2017 enhances the awareness for elevated BP in children, particularly in patients with increased risk for cardiovascular disease. Elevated BP should prompt further evaluation, but not the immediate start of antihypertensive medication.
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