Abstract

Background Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents.

Methods 244 participants (mean age 15.5±1.8 years, 60.1% male) were studied. Participants were divided based on both systolic clinic and ambulatory BP (ABP), into low- (<75th percentile), mid- (75th-90th percentile) and high-risk (>90th percentile) groups. TOI assessments included left ventricular mass, systolic and diastolic function, and vascular stiffness. The number of TOI markers for each participant was calculated. A multivariable general linear model was constructed to evaluate the association of different participant characteristics with higher numbers of TOI markers.

Results 47.5% of participants had at least one TOI marker: 31.2% had one, 11.9% two, 3.7% three, and 0.8% four. The number of TOI markers increased according to the BP risk groups: the percentage of participants with more than one TOI in the low-, mid-, and high groups based on clinic BP was 6.7%, 19.1%, and 21.8% (p=0.02), and based on ABP was 9.6%, 15.8%, and 32.2% (p<0.001). In a multivariable regression analysis, both clinic BP percentile and ambulatory SBP index were independently associated with the number of TOI markers. When both clinic and ABP were included in the model, only the ambulatory SBP index was significantly associated with the number of markers.

Conclusion High SBP, especially when assessed by ABPM, was associated with an increasing number of subclinical cardiovascular injury markers in adolescents.

Competing Interest Statement

Elaine M Urbina serves as a consultant to Targus Medical Inc and Astellas (DSMB).

Funding Statement

Supported by the American Heart Association funding (Grant #15SFRN23680000) to Cincinnati Childrens Hospital Medical Center and University of Cincinnati College of Medicine; and by NIH National Center for Advancing Translational Sciences grants to the University of Cincinnati (#UL1 TR001425), University of Washington (#UL1 TR002319), and University of Rochester (#UL1 TR002001).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of Cincinnati Childrens Hospital Medical Center gave ethical approval for this work. IRB of Boston Childrens Hospital gave ethical approval for this work. IRB of Seattle Childrens Hospital gave ethical approval for this work. IRB of University of Rochester Medical Center gave ethical approval for this work. IRB of Childrens Hospital of Phildelphia gave ethical approval for this work. IRB of McGovern Medical School at University of Texas Health and Childrens Memorial Hermann Hospital gave ethical approval for this work.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Data Availability

This choort's data is not available for public access.

List of Non-standard AbbreviationsABPAmbulatory Blood PressureABPMAmbulatory Blood Pressure MonitoringAHAAmerican Heart AssociationCKDChronic Kidney DiseaseGLSGlobal Longitudinal StrainLVHLeft Ventricular HypertrophyLVMILeft Ventricular Mass IndexPWVPulse Wave VelocitySBPSystolic Blood PressureTOITarget Organ Injury