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Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines

Hill-Horowitz, Taylor; Merchant, Kumail; Abdullah, Mahie; Castellanos-Reyes, Laura; Singer, Pamela; Dukkipati, Haripriya; Frank, Rachel; Sethna, Christine B; Basalely, Abby
Objectives To describe the epidemiology of reclassification of prehypertensive and unclassified adolescents by 2022 American Heart Association (AHA) pediatric ambulatory blood pressure monitoring (ABPM) guidelines, and to evaluate the association of the new diagnostic categories with left ventricular hypertrophy (LVH). Study Design A single-center, retrospective review of ABPM reports from adolescents 13-21 years old, from 2015 through 2022, was performed. Adolescents with prehypertension or unclassified by 2014 guidelines were reclassified by 2022 definitions. Logistic regression models evaluated the association of reclassification phenotypes with LVH. Results A majority of prehypertensive adolescents reclassified to hypertension (70%, N=49/70). Over half (57%, N=28/49) of hypertension was isolated nocturnal hypertension, and 80% was systolic hypertension. Reclassification to hypertension was more common in males. The majority (55.6%) of unclassified adolescents were reclassified to normotension. No demographic or clinical variables were associated with reclassification categories. LVH was not associated with hypertension in the reclassified prehypertensive or unclassified groups. Conclusions The 2022 ABPM guidelines clearly define BP phenotypes. However, reclassification to hypertension was not associated with increased odds of LVH. As most prehypertensive adolescents reclassified as hypertensive by nighttime BPs alone, this study highlights the lowered threshold for nocturnal hypertension. Prospective studies in larger, well-defined cohorts are needed to describe better the predictive value of 2022 BP phenotypes for target organ damage.
PMID: 38154521
ISSN: 1097-6833
CID: 5623342

Voiding Disorders in Children

Chandra, Manju; Merchant, Kumail
Purpose of review: This review will inform the physiology of urine storage, bladder emptying, volitional control of voiding, pathogenesis, management of the most common voiding disorders in children, including overactive bladder (OAB)"“induced diurnal urinary urgency and urge incontinence, nocturnal enuresis (NE), and dysfunctional voiding from functional detrusor-external sphincter dyssynergy. Recent findings: OAB and NE often result from delayed maturation or pathological alteration of central nervous system control over the lower urinary tract and may coexist with learning and psychosocial problems, attention deficit hyperactivity disorder (ADHD), and incomplete defecation. Children with OAB are at risk of developing dysfunctional obstructed voiding, recurrent urinary tract infections (UTIs), secondary onset of vesicoureteral reflux (VUR), detrusor fibrosis, and upper tract damage. To achieve voiding control, bowel elimination habits must be normalized and associated psychosocial problems must be addressed. Treatment involves an individualized, patient-centric approach. Summary: Childhood voiding disorders have complex pathophysiology and may contribute to comorbid conditions including VUR and UTIs. Individualized therapy includes education, behavioral interventions, pharmacotherapy, and use of devices. Current treatment strategies can yield over 90% response rate when instituted correctly. Further studies are needed to understand the neural circuits involved in voiding control and expand treatment options for voiding disorders.
SCOPUS:85127619466
ISSN: 2198-6088
CID: 5198742

Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19

Basalely, Abby; Gurusinghe, Shari; Schneider, James; Shah, Sareen S; Siegel, Linda B; Pollack, Gabrielle; Singer, Pamela; Castellanos-Reyes, Laura J; Fishbane, Steven; Jhaveri, Kenar D; Mitchell, Elizabeth; Merchant, Kumail; Capone, Christine; Gefen, Ashley M; Steinberg, Julie; Sethna, Christine B
This study describes the incidence, associated clinical characteristics and outcomes of acute kidney injury in a pediatric cohort with COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C). We performed a retrospective study of patients 18 years of age and under admitted to four New York hospitals in the Northwell Health System interned during the height of the COVID-19 pandemic, between March 9 and August 13, 2020. Acute kidney injury was defined and staged according to Kidney Disease: Improving Global Outcomes criteria. The cohort included 152 patients; 97 acute-COVID-19 and 55 with MIS-C associated with COVID-19. Acute kidney injury occurred in 8 with acute-COVID-19 and in 10 with MIS-C. Acute kidney injury, in unadjusted models, was associated with a lower serum albumin level (odds ratio 0.17; 95% confidence interval 0.07, 0.39) and higher white blood cell counts (odds ratio 1.11; 95% confidence interval 1.04, 1.2). Patients with MIS-C and acute kidney injury had significantly greater rates of systolic dysfunction, compared to those without (80% vs 49%). In unadjusted models, patients with acute kidney injury had 8.4 days longer hospitalizations compared to patients without acute kidney injury (95% confidence interval, 4.4-6.7). Acute kidney injury in acute-COVID-19 and MIS-C may be related to inflammation and/or dehydration. Further research in larger pediatric cohorts is needed to better characterize risk factors for acute kidney injury in acute-COVID-19 and with MIS-C consequent to COVID-19.
PMID: 33675848
ISSN: 1523-1755
CID: 5047692

Comparison of Pediatric and Adult Ambulatory Blood Pressure Monitoring Criteria for the Diagnosis of Hypertension and Detection of Left Ventricular Hypertrophy in Adolescents

Merchant, Kumail; Shah, Paras P; Singer, Pamela; Castellanos, Laura; Sethna, Christine B
OBJECTIVE:To compare pediatric ambulatory blood pressure monitoring (ABPM) criteria with adult ABPM criteria for the diagnosis of hypertension and detection of left ventricular hypertrophy (LVH) in adolescents. STUDY DESIGN:). RESULTS:were hypertensive by adult criteria, 8 of these individuals were missed by pediatric criteria. CONCLUSIONS:Adult criteria captured a higher prevalence of LVH and appeared to predict better LVH than pediatric criteria. A consideration to align ABPM criteria for diagnosing hypertension in adolescents with adult guidelines is warranted.
PMID: 33181197
ISSN: 1097-6833
CID: 5047682

Left ventricular cardiac geometry and ambulatory blood pressure in children

Shilly, Steffi; Merchant, Kumail; Singer, Pamela; Frank, Rachel; Gurusinghe, Shari; Infante, Lulette; Sethna, Christine B
Limited information is available regarding the relationship between ambulatory blood pressure monitoring (ABPM) and cardiac geometry in hypertensive children. ABPM and 2D-echocardiography were retrospectively reviewed in children and adolescents <21 years old with primary hypertension. A total of 119 participants (median age 15.0 [IQR 12, 16] years) with hypertension were included. Left ventricular hypertrophy was diagnosed in 39.5% of participants. Normal geometry was found in 47.1%, concentric remodeling (CR) in 13.4%, concentric hypertrophy (CH) in 15.1%, and eccentric hypertrophy (EH) in 24.4% of children. After adjustment for age, sex, and body mass index z-score, awake systolic blood pressure (BP) index (BPi) (OR 1.07, 95% CI: 1.001-1.14, P = 0.045), awake diastolic BPi (OR 1.04, 95% CI: 1.00-1.09, P = 0.048), awake systolic BP load (OR 1.02, 95% CI: 1.000-1.04, P = 0.047), and sleep systolic BP load (OR 1.02, 95% CI: 1.001-1.04, P = 0.03) were directly associated with CH. No ABPM parameters were significant predictors of EH. In conclusion, ABPM parameters were found to be independent predictors of cardiac geometry, specifically CH.
PMID: 30980607
ISSN: 1751-7176
CID: 5047672

Cardiovascular Disease Risk in Children With Kidney Disease

Sethna, Christine B; Merchant, Kumail; Reyes, Abigail
Cardiovascular disease is a major cause of death in individuals diagnosed with kidney disease during childhood. Children with kidney disease often incur a significant cardiovascular burden that leads to increased risk for cardiovascular disease. Evidence has shown that children with kidney disease, including chronic kidney disease, dialysis, kidney transplantation, and nephrotic syndrome, develop abnormalities in cardiovascular markers such as hypertension, dyslipidemia, left ventricular hypertrophy, left ventricular dysfunction, atherosclerosis, and aortic stiffness. Early identification of modifiable risk factors and treatment may lead to a decrease of long-term cardiovascular morbidity and mortality, but evidence in this population is lacking.
PMID: 29753405
ISSN: 1558-4488
CID: 5047662