Abstract Body: Background: Early intervention for modifiable cardiovascular (CV) health factors may decrease incidence of CV disease later in life, though whether youth at higher risk are more likely to have CV assessment and intervention is unknown. Our objective was to determine CV health initial assessment and intervention including echocardiogram (ECHO) order, anti-hypertensive medication prescription, and dietician referral by participant risk category from the 2019 American Heart Association (AHA) CV Risk Reduction in High-Risk Pediatric Patients scientific statement in a large cohort of youth with hypertension (HTN) disorders.

Methods: Cross-sectional analysis of baseline data from the SUPERHERO Registry, a multisite retrospective cohort of youth referred for HTN disorders. Inclusion criteria were age <19 years and HTN disorder identified by ICD-10 codes from 1/1/2015–12/31/2023 at index visit to a subspecialty clinic. Exclusion criteria were kidney replacement therapy by dialysis or transplant or pregnancy by ICD-10 codes. Exposure was AHA Pediatric Risk Category (High, Moderate, At-risk). We used clinic BP by U.S. guidelines, clinic BMI percentile to define obesity, and ICD-10 codes to define other risk category medical diagnoses. Outcomes were ECHO order, anti-hypertensive medication prescription, and dietician referral. We used unadjusted generalized linear models.

Results: Of 9356 participants, 1034 (11.1%), 6100 (65.2%), and 634 (6.8%) participants were categorized as High, Moderate, and At-risk groups. Overall, 3053 (32.6%) of participants had an ECHO order, 943 (16.4%) had anti-hypertensive medication prescribed, and 661 (7.1%) had a dietician referral. With At-risk group as reference, participants in High or Moderate risk groups were more likely to have an anti-hypertensive medication prescription (RR 3.12; 95% CL 2.23 to 4.36, RR 1.38; 95% CL 1.02 to 1.85). Participants in the Moderate risk group were more likely to have an ECHO order (RR 1.24; 95% CL 1.06 to 1.44). No difference between risk groups was seen for dietician referral.

Conclusions: Among a large cohort of youth with HTN disorders, we found that higher risk groups were more likely to have an anti-hypertensive medication prescribed compared to lower risk group. The overall proportion of participants with medication prescriptions, ECHO orders, or dietician referrals were low. Next steps include investigating the association of risk category with target organ injury.