Abstract Body: Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, with prevalence increasing in youth. It remains unknown if MASLD influences initial management decisions including antihypertensive medication prescription and dietitian referral in youth with HTN disorders.

Objective: Investigate the relationships among MASLD and initial management at baseline in youth with HTN disorders.

Design/Methods: Cross- sectional analysis of baseline data from the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO) Registry, a multisite retrospective cohort of youth referred to subspecialty care for hypertension disorders using electronic health record data. Inclusion criteria were an initial subspecialty clinic visit for HTN disorders identified by ICD-10 codes from 1/1/2016–12/31/2023 and age <19 years. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. Exposure included MASLD identified by ICD-10 codes. Outcomes were initial hypertensive medication prescription, orders placed for echocardiograms, and dietitian referral +/- 6 months around the index visit. We used unadjusted generalized linear models to determine if there was an association between MASLD and the outcomes.

Results: Of the 9,356 participants, the mean age was 12.8 ± SD 4.5 years, 38% were female, 10% were prescribed antihypertensive medication, 7% had an order for dietitian referral, and 33% had an order for an echocardiogram. MASLD occurred in 1% (n=132) of participants. Participants with MASLD were not more likely to have antihypertensive medication prescription (RR 1.76, 95% CL 0.99 to 3.1), dietitian referral (RR 0.85, CL 0.43 to 1.72), or echocardiogram order (RR 0.9, CL 0.66 to 1.24).

Conclusions: In a large multisite cohort of youth referred for HTN disorders with MASLD, initial management including prescription order and dietitian referral was not significantly different compared to patients without MASLD. We identified important gaps in care, including only 7% of participants having an order for dietitian referral despite the important role of lifestyle management in both MASLD and HTN disorders. A limitation of this work is that all dietitian referrals may not have been fully captured via ICD-10 codes. Future studies will investigate causes of health care disparities to inform future management of youth with HTN disorders.