Association of Blood Pressure–Related Increase in Vascular Stiffness on Other Measures of Target Organ Damage in Youth

Haley, Jessica E.; Woodly, Shalayna A; Daniels, Stephen R.; Falkner, Bonita; Ferguson, Michael; Flynn, Joseph T.; Hanevold, Coral; Hooper, Stephen R.; Ingelfinger, Julie R.; Khoury, Philip R.; Lande, Marc B.; Martin, Lisa J.; Meyers, Kevin; Mitsnefes, Mark; Becker, Richard C.; Rosner, Bernard; Samuels, Joshua; Tran, Andrew; Urbina, Elaine M.

doi:10.1161/hypertensionaha.121.18765

Cited by 18 publications

(13 citation statements)

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“…PWV and aortic compliance were significantly associated with measures of TOD (systolic and diastolic cardiac function and urine albumin/creatinine ratio) after controlling for BP level. These results indicate that BP-related vascular stiffness can also be detected at BP levels below the 95th percentile (23). Moreover, in this analysis, low-density lipoprotein (LDL) level was significantly associated with vascular stiffness.…”

Section: Markers Of Cardiovascular Injury In Youthmentioning

confidence: 54%

The enigma of primary hypertension in childhood

Falkner

2022

Front. Cardiovasc. Med.

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Beginning in the 1970s, hypertension in children and adolescents has been defined as systolic and/or diastolic blood pressure (BP) that is equal to or greater than the 95th percentile of the normal BP distribution in healthy children. The definition of hypertension in adults is based on longitudinal data that links a BP level with an increased risk for subsequent adverse outcomes related to hypertension including heart failure, kidney failure, stroke, or death. The statistical definition of hypertension continues to be used in childhood because there have been no data that link a BP level in childhood with a heightened risk for adverse outcomes in adulthood. Findings from clinical and epidemiologic research have advanced understanding of high BP in childhood. While hypertension in some children can be secondary to underlying kidney, cardiovascular, or endocrine disorder, it is now known that primary (essential) hypertension can be present in childhood. The prevalence of hypertension in childhood is approximately 2–5% and another 13–18% of children and adolescents have elevated BP and are at heightened risk for developing hypertension. The leading cause of childhood hypertension is primary hypertension, especially in adolescents. For children and adolescents with secondary hypertension, the treatment can focus on managing the underlying cause of hypertension. Less is known about managing primary hypertension in childhood, including diagnosis, evaluation, treatment, and possibilities for prevention. The phenotype of primary hypertension in childhood and recent findings will be discussed.

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Section: Markers Of Cardiovascular Injury In Youthmentioning

confidence: 54%

The enigma of primary hypertension in childhood

Falkner

2022

Front. Cardiovasc. Med.

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“…44 Furthermore, the usefulness of cIMT as a predictor may depend on the methodologic approach to measurement. 30 BP during adolescence has also been associated with increased central arterial stiffness 24,45 and subclinical cognitive dysfunction. 46 Effects of childhood BP on the microvasculature is less well described with no difference in microalbuminuria between normotensive and hypertensive adolescents found, 45,47 although 20% of children with primary hypertension (mean age, 16.5 years) had a random urine albumin to creatinine ratio of >3.2 mg/mmol creatinine in a retrospective chart review.…”

Section: Relation Of Child Bp To Subclinical Cardiovascular Diseasementioning

confidence: 99%

“…30 BP during adolescence has also been associated with increased central arterial stiffness 24,45 and subclinical cognitive dysfunction. 46 Effects of childhood BP on the microvasculature is less well described with no difference in microalbuminuria between normotensive and hypertensive adolescents found, 45,47 although 20% of children with primary hypertension (mean age, 16.5 years) had a random urine albumin to creatinine ratio of >3.2 mg/mmol creatinine in a retrospective chart review. 48 In a study of Israeli conscriptees (N=589 702; age, 16-20 years), 0.3% of adolescents with BP ≥130/80 mm Hg developed early kidney damage after 15.1 years, 49 and adolescent BP in this cohort has also been related to adult end-stage renal disease 50 and type 2 diabetes.…”

Section: Relation Of Child Bp To Subclinical Cardiovascular Diseasementioning

confidence: 99%

“…45 Cognitive changes in hypertensive youth have also been demonstrated, 46 but the effect sizes were small. Finally, arterial stiffening has been associated with elevated BP in youth 64 and was associated with abnormalities in cardiac structure 65 and function. 66 However, there are no follow-up studies to determine the relative importance of these BP-related target organ changes in predicting future cardiovascular diseases.…”

Section: Gaps In Knowledgementioning

confidence: 99%

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Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here?

2023

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The association between hypertension in adulthood and cardiovascular morbidity and mortality is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.

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“…It is estimated that hypertension is prevalent in 4 out of every 100 youth [1][2][3] but underdiagnosed in 74% of cases. 3,4 Hypertension can begin in childhood and is a predominant cause of target organ damage in childhood 5,6 and cardiovascular disease (CVD) in adulthood. 7 A diagnosis of hypertension is made in individuals younger than 13 years when the average blood pressure (BP) across 2 to 3 visits equals or exceeds the 95th percentile; in individuals 13 years of age or older, hypertension is diagnosed when the average BP equals or exceeds 130/80 mm Hg.…”

Section: Introductionmentioning

confidence: 99%

Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware

et al. 2023

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ImportanceThe association between degree of neighborhood deprivation and primary hypertension diagnosis in youth remains understudied.ObjectiveTo assess the association between neighborhood measures of deprivation and primary hypertension diagnosis in youth.Design, Setting, and ParticipantsThis cross-sectional study included 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between January 1, 2014, and December 31, 2019. Residence was geocoded by national area deprivation index (ADI).ExposuresHigher area deprivation.Main Outcomes and MeasuresThe main outcome was primary hypertension diagnosis based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Data were analyzed between September 1, 2021, and December 31, 2022.ResultsA total of 65 452 youths were included in the analysis, including 64 307 (98.3%) without a hypertension diagnosis (30 491 [47%] female and 33 813 [53%] male; mean [SD] age, 12.5 (3.1) years; 12 500 [19%] Hispanic, 25 473 [40%] non-Hispanic Black, 24 565 [38%] non-Hispanic White, and 1769 [3%] other race or ethnicity; 13 029 [20%] with obesity; and 31 548 [49%] with an ADI ≥50) and 1145 (1.7%) with a diagnosis of primary hypertension (mean [SD] age, 13.3 [2.8] years; 464 [41%] female and 681 [59%] male; 271 [24%] Hispanic, 460 [40%] non-Hispanic Black, 396 [35%] non-Hispanic White, and 18 [2%] of other race or ethnicity; 705 [62%] with obesity; and 614 [54%] with an ADI ≥50). The mean (SD) duration of full Medicaid benefit coverage was 61 (16) months for those with a diagnosis of primary hypertension and 46.0 (24.3) months for those without. By multivariable logistic regression, residence within communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis (odds ratio [OR], 1.61; 95% CI 1.04-2.51). Older age (OR per year, 1.16; 95%, CI, 1.14-1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54-5.85), and longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03-1.04) were associated with greater odds of primary hypertension diagnosis, whereas female sex was associated with lower odds (OR, 0.68; 95%, 0.61-0.77). Model fit including a Medicaid-by-ADI interaction term was significant for the interaction and revealed slightly greater odds of hypertension diagnosis for youths with ADI less than 50 (OR, 1.03; 95% CI, 1.03-1.04) vs ADI ≥50 (OR, 1.02; 95% CI, 1.02-1.03). Race and ethnicity were not associated with primary hypertension diagnosis.Conclusions and RelevanceIn this cross-sectional study, higher childhood neighborhood ADI, obesity, age, sex, and duration of Medicaid benefit coverage were associated with a primary hypertension diagnosis in youth. Screening algorithms and national guidelines may consider the importance of ADI when assessing for the presence and prevalence of primary hypertension in youth.

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Association of Blood Pressure–Related Increase in Vascular Stiffness on Other Measures of Target Organ Damage in Youth

Cited by 18 publications

References 62 publications

The enigma of primary hypertension in childhood

The enigma of primary hypertension in childhood

Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here?

Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware

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