Abstract Body (Do not enter title and authors here): Background: Given the increasingly high prevalence of adverse cardiovascular (CV) health in adults and its relationship with numerous organ systems, an AHA Presidential Advisory recently defined CV-kidney-metabolic (CKM) syndrome. However, CKM syndrome prevalence and presence of sex disparities are unknown in youth with hypertension disorders.

Methods: Cross-sectional descriptive and inferential analysis of baseline data from 7 sites in the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective Registry of electronic health record data using standardized biomedical informatics scripts and validated by manual record review. Inclusion criteria were youth <19 years old who received care from subspecialists for hypertension disorders from 1/1/2016–12/31/2023 defined by ICD-10 codes. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. We defined CKM syndrome as Stage 2, Stage 1, Stage 0, or Unclassified using ICD-10 codes and recorded BP and BMI (Figure 1). We reported mean (SD) and n (%) and used directed acyclic graph-informed generalized linear models.

Results: Of 9,356 participants, mean age was 12.8 years (SD 4.5) and 38% were female. CKM syndrome prevalence was 85% (20% Stage 1, 65% Stage 2), and 7% were Unclassified. Table 1 describes the various health conditions by CKM syndrome staging. Among the 8,726 participants with known staging, female sex was not associated with worse CKM syndrome (RR 1.04, 95% CL 0.95–1.14).

Discussion: In this novel study of youth with hypertension disorders, CKM syndrome was common (85% at baseline) but there were no sex differences. Ongoing SUPERHERO steps are improving CKM syndrome case definition. Future analyses will investigate CKM syndrome’s relationship with social determinants of health and outcomes. Presence of CKM syndrome could inform innovative primordial and primary preventative interventions, and hypertension treatment, in youth to greatly improve CV health across the life course.