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/m 2.7 ; 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/m 2.7 ). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.
Although hypertension is identifiable in children and adolescents, there are many knowledge gaps on how to best define and manage high blood pressure in the young. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth) is being conducted to address these knowledge gaps. Five hundred adolescents will be recruited and will undergo ambulatory blood pressure monitoring, echocardiographic, vascular, and cognitive assessments, as well as epigenetic studies to identify mechanisms that underlie the development of hypertensive target organ damage. Details of the design and methods that will be utilized in SHIP-AHOY are presented here, as well as baseline characteristics of the first 264 study participants. The primary aim of the study is to develop a risk-based definition of hypertension in the young that will result in better understanding of the transition from blood pressure in youth to adult cardiovascular disease.
ardiometabolic risk factors associated with the development of insulin resistance (IR), such as obesity, hypertension, and dyslipidemia, promote the development of atherosclerosis. These cardiovascular risk factors not only are evident in youth, but also are known to track into adulthood. Unfortunately, risk factor-related vascular changes are occurring early in life, as seen in data from autopsies performed on participants in the Bogalusa Heart Study, where adverse values of body mass index (BMI), blood pressure (BP), smoking, and serum cholesterol-specifically total, low-density lipoprotein, and high-density lipoprotein cholesterol-were associated with coronary and aortic fatty streaks in subjects aged 2-39 years. 1 Similar findings (other than an association with low-density lipoprotein cholesterol) were seen in the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) autopsy study. 2 Recent studies in youth have used noninvasive testing to demonstrate early atherosclerosis. These studies have used various modalities to differentiate "normal" and "accelerated" vascular aging by demonstrating adverse changes in the arteries in high-risk youth. In a recent article published in The Journal, Hughan et al 3 compared pulse wave velocity (PWV), a measure of arterial stiffness, and carotid intima-media thickness (cIMT), reflecting atherosclerosis, and endothelial function biomarkers among girls with obesity with and without polycystic ovary syndrome (PCOS) and healthy, normal-weight girls in a crosssectional fashion. 3 They found significantly stiffer arteries (ie, increased PWV) in the obese youth with or without PCOS compared with controls, even when adjusted for age, race, and BP (P = .002). There was no difference in cIMT among the 3 groups; however, there were differences in endothelial biomarkers, specifically VCAM-1 (P = .03). In addition, correlations between PWV and traditional cardiovascular (CV) risk factors demonstrated that PWV had the closest correlation with BMI. The authors concluded that obesity is the more important factor leading to abnormalities in vascular function in PCOS. In this review, we discuss the available evidence linking obesity-related CV risk factors in youth and the noninvasive measures of vascular structure and function.
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