Use of Ambulatory Blood Pressure Monitoring Among Commercially Insured Youth and Young Adults with Hypertension or CKD, 2017-2021

Background: Out-of-office blood pressure (BP) provides valuable information with better prognostic value than clinic-measured BP. Ambulatory BP monitoring (ABPM) is recommended in pediatric and adult hypertension (HTN) and chronic kidney disease (CKD) guidelines; however, ABPM use rates (episodes) in clinical practice in the US for high-risk patients are unknown. Here, we estimate those rates among a large cohort of commercially insured youth and young adults. Furthermore, we investigate the association of ABPM episodes billed with rurality of participant residence. Methods: Retrospective cohort study using Merative Marketscan commercial claims data from Jan 2017 to Dec 2021. Inclusion criteria were two encounters with qualifying diagnoses of HTN or CKD from 2017–2020 (with second encounter defining index date), age 4 to 35 yrs at time of index date, and continuous insurance coverage from index date to at least 12 months after. Exclusion criterion was pregnancy. ABPM incidence rates were measured from index date through end of case-specific follow-up period for each diagnostic group. We stratified our population into pediatric (4–17 yo) and adult (18–34 yo) participants. Results: Of 327,093 participants, 95.6% of participants had HTN, 2.0% CKD, and 2.4% both HTN and CKD. In the 20,874 pediatric cases, ABPM episodes occurred in 8.8% of participants with HTN alone, in 3.6% of participants with CKD alone, and in 21.4% of participants with both HTN and CKD. For the 307,029 adult participants, ABPM episodes occurred in 0.5% of participants with HTN alone, in 0.4% of participants with CKD alone, and in 1.7% of participants with both HTN and CKD. Participants in rural locations were less likely to complete an ABPM episode compared to participants in urban locations (0.7% vs. 1.1%; odds ratio 0.58; 95% CL 0.52 to 0.66). Conclusion: Incidence of ABPM episode billed for participants 2017-2020 was lower than recommended among all groups, especially in adults. Pediatric and adult participants with CKD in the US are not receiving guideline-recommended care for HTN. There is a need to identify barriers to ABPM or, particularly for pediatrics, alternative validated methods for out-of-office BP measurement critical to HTN control in this population.