Abstract Body: Introduction:
Youth-onset hypertension frequently co-occurs with psychiatric disorders, complicating clinical management. Despite increased awareness, standardized protocols remain limited, and the impact of mental, behavioral, and emotional (MBE) health conditions on initial hypertension management is poorly understood. This study estimates the association between MBE diagnoses and initial hypertension management for youth with hypertension disorders.

Hypothesis:
We assessed the hypothesis that youth with hypertension and concurrent MBE diagnoses are less likely to receive guideline-concordant initial hypertension management.

Methods:
This cross-sectional analysis used baseline data from seven sites in the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective registry of electronic health record data. Inclusion criteria were youth <19 years old receiving care from sub-specialists for hypertension disorders from 1/1/2016–12/31/2023. Exclusion criteria included kidney failure on dialysis, kidney transplant, and pregnancy. Exposures were MBE diagnoses (ICD-10: F01-F99). Outcomes were antihypertensive prescription, dietitian referral, and echocardiogram order and assessed +/- 6 months around index visit. Relative risks were estimated using generalized linear models with a log link and binomial distribution.

Results:
Of the 9,356 participants, 38% were female, and the mean age was 12.8 years (SD 4.5). Eight percent (n=769) had an MBE diagnosis. In adjusted analyses, MBE diagnoses were not associated with differences in antihypertensive medication prescription (RR 0.92; 95% CI 0.66–1.27). However, youth with MBE diagnoses were significantly more likely to receive a dietitian referral (RR 1.63; 95% CI 1.29–2.06). Unadjusted comparisons showed lower echocardiogram orders among youth with MBE diagnoses (28% vs. 33%, p=0.003), though this was not statistically significant after adjusting for clinical and social confounders (RR 1.04; 95% CI 0.94–1.16).

Conclusions:
In this analysis of youth with hypertension disorders, MBE diagnoses were associated with increased dietitian referrals at baseline but not with prescription or imaging differences. Future steps in SUPERHERO include studying antihypertensive classes and evaluating longitudinal outcomes such as blood pressure control and health service use. In conclusion, our results support further research into integrated models that prioritize MBE health in hypertension management.