Abstract 4143731: Point of Care Ambulatory Blood Pressure Monitoring for Diagnosing Hypertension is Accepted by Youth, Parents, and Primary Providers

Introduction: Residence within a high deprivation community is associated with a greater odds of hypertension diagnosis in youth. Providers cite uncertainty about the etiology of an abnormal blood pressure (BP) measurement (white coat vs HTN) as a potential barrier to diagnosis. Placement of a 24-hour ambulatory BP monitoring (ABPM) device in the pediatric primary care (PPC) setting – “point of care” ABPM – represents a novel approach to diagnosing HTN in youth. Hypothesis: “Point of care” ABPM is (1) accepted by youth, parents, and PPC providers and (2) reduces PPC provider uncertainty regarding a diagnosis of HTN in youth. Aims: Qualitative assessment of factors associated with acceptance of “point of care” ABPM and acceptance of subsequent HTN diagnosis. Methods: “Point of care” ABPM was made available within a single, high deprivation PPC practice in Wilmington, DE. It was offered when manual BP measured > 95th (age 10-12 years) or > 130/80mmHg (13-17 years). Individual qualitative interviews of youth, their parents, and their providers were conducted by trained study team members. Qualitative data were coded and analyzed using an inductive thematic approach. Results: Twenty-five youth, 25 parents, and 8 PPC providers completed interviews. ABPM decision-making was influenced by perceptions of 1) importance of early HTN detection, 2) benefits/convenience of ABPM, 3) concerns regarding activity restrictions/discomfort, and 4) trust in the PPC provider (Table 1). Most parents and all providers reported high confidence in ABPM results, which they attributed to multiple BP readings in a comfortable environment, diagnosis consistent with family history, and trust in the PPC provider. Many youth/parents reported comfort with HTN management recommendations (e.g., lifestyle intervention, referral to subspecialist). Conclusions: “Point of care” ABPM is accepted by youth and their parents due to perceived high importance of early HTN detection. Youth, parent, and PPC provider confidence in the diagnosis of HTN was aided by the multiple BP readings captured by the ABPM device and measurements that were obtained in a comfortable environment. Trust in the PPC provider was also an important factor impacting both decision making and confidence in “point of care” ABPM results.