Elaine M Urbina1, Brenda Mendizábal2, Richard C Becker3, Steve R Daniels4, Bonita E Falkner5, Gilad Hamdani6, Coral Hanevold7, Stephen R Hooper8, Julie R Ingelfinger9, Marc Lanade10, Lisa J Martin11, Kevin Meyers12, Mark Mitsnefes13, Bernard Rosner14, Joshua Samuels15, Joseph T Flynn7. 1. From the Division of Preventive Cardiology (E.M.U.), Cincinnati Children's Hospital Medical Center, OH. 2. Children's Hospital of Pittsburgh (B.M.). 3. Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.C.B.). 4. Department of Pediatrics, Denver Children's Hospital, CO (S.D.). 5. Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.E.F.). 6. Schneider Children's Medical Center of Israel, Tel Aviv, Israel (G.H.). 7. Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.). 8. Department of Allied Health Sciences, University of North Carolina School of Medicine (S.R.H.). 9. Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children, Massachusetts General Hospital, Boston (J.R.I.). 10. Department of Pediatrics, University of Rochester Medical Center, NY (M.L.). 11. Division of Human Genetics (L.J.M.), Cincinnati Children's Hospital Medical Center, OH. 12. Division of Nephrology and Hypertension, Children's Hospital of Philadelphia, PA (K.M.). 13. Division of Nephrology and Hypertension (M.M.), Cincinnati Children's Hospital Medical Center, OH. 14. Harvard University (B.R.). 15. Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas in Houston (J.S.).
Abstract
Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80-<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m2.7; LVH: L=13%, M=21%, H=27%, all P<0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m2.7). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.
Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80-<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m2.7; LVH: L=13%, M=21%, H=27%, all P<0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m2.7). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.
Entities:
Keywords:
adolescent; blood pressure; body mass index; hypertension; hypertrophy, left ventricular
Authors: Jessica E Haley; Shalayna A Woodly; Stephen R Daniels; Bonita Falkner; Michael A Ferguson; Joseph T Flynn; Coral D Hanevold; Stephen R Hooper; Julie R Ingelfinger; Philip R Khoury; Marc B Lande; Lisa J Martin; Kevin E Meyers; Mark Mitsnefes; Richard C Becker; Bernard A Rosner; Joshua Samuels; Andrew H Tran; Elaine M Urbina Journal: Hypertension Date: 2022-06-28 Impact factor: 9.897
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