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SAN DIEGO -- An effort to better characterize the epidemiology of youth with hypertension disorders pointed to primary hypertension as the dominant etiology in older children and those with worse systolic blood pressure (BP), whereas preterm birth was not documented enough to show a relationship with hypertension.

In preliminary data from the SUPERHERO registry, a retrospective cohort of youth referred for subspecialty care for hypertension disorders, patients over age 13 years, and peers with increased systolic BP, tended to develop more primary hypertension as opposed to secondary hypertension, according to Donald Weaver Jr., MD, PhD, of Wake Forest School of Medicine in Winston-Salem, North Carolina.

This supports the common belief that primary hypertension is the dominant etiology at older ages, especially so in adolescents. Moreover, the registry showed that in cases of secondary hypertension, the cause was less often attributed to the kidneys, he said in a presentation at the Hypertension meeting hosted by the American Heart Association.

Notably, there was a high 54% prevalence of obesity in the SUPERHERO cohort. Weaver said that the prevalence of obesity in youth is increasing concomitantly with primary hypertension.

Additionally, by race, 45% of the cohort were white, 29% Black, and 17% Hispanic.

Session co-moderator Gbenga Ogedegbe, MD, of NYU Langone Health in New York City, stressed the importance of teasing out differences in childhood BP in the context of race and ethnicity being social constructs.

Previously, African=American teenagers have been described as having compared with other racial groups. Yet one study found genetics were not to blame for worse outcomes for Black people in the SPRINT trial.

"We are very sensitive" to the issue of health disparities, Weaver said. He noted that there is ongoing work on SUPERHERO incorporating neighborhood-level data from the U.S. Census.

The SUPERHERO registry was started in June 2021. The present interim report was based on electronic health records data from nearly 3,300 patients at the first three participating sites: Atrium Health Levine Children's Hospital in Charlotte, North Carolina; Wake Forest Brenner Children's Hospital; and Hofstra/Northwell Cohen Children's Medical Center in New Hyde Park, New York.

Since then, the registry has grown to include 15 sites in North America with a total sample of approximately 14,000 children with a plan to continue expanding, Weaver said.

The registry included 3,295 individuals under age 19 years with an initial visit for hypertension from 2016 to 2021. Exclusion criteria were pregnancy, dialysis, and renal transplant. Median age was 14 years, and 37% of the cohort were girls.

Baseline BP severity was listed as stage 2 hypertension in 26%, stage 1 hypertension in 34%, and elevated BP in 17%.

Primary hypertension dominated hypertension disorder diagnoses, with a prevalence of 58%. In contrast, secondary hypertension was diagnosed in just 14% -- most commonly unspecified rather than attributed to a kidney or non-kidney cause.

Weaver cautioned that diagnoses were based only on ICD-10 codes in this interim report. The next phase of the study will have investigators incorporating lab values and imaging studies to confirm or rule out secondary causes of pediatric hypertension.

The SUPERHERO group also attempted a separate analysis describing the association between preterm birth and hypertensive disorders. No such association was found to be significant.

As fewer than 1% of the cohort had an ICD-10 code for preterm birth, however, the authors are still working on obtaining actual gestational ages at birth and probing any associations with target organ damage, Weaver said.

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