Ambulatory Blood Pressure Phenotype and Cardiovascular Risk in Youth: The SHIP-AHOY Study

Abstract

Objective: To determine whether a specific blood pressure (BP) phenotype, based on clinic and 24-hour ambulatory BP (ABP), is associated with markers of target organ damage in otherwise healthy youth.

Study design: In 373 adolescents enrolled in a cross-sectional study of the relationship of BP to cardiovascular risk (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth [SHIP-AHOY], clinic BP was measured by auscultation and categorized using the 2017 American Academy of Pediatrics guideline. ABP was measured for 24 hours by an oscillometric device and analyzed using the adult ABP wake systolic BP cut-point (130 mmHg), creating 4 BP phenotype groups: normal BP (n = 212), white coat hypertensive (n = 55), ambulatory hypertensive (n = 63), and masked hypertensive (n = 43). Echocardiographic measures and carotid-femoral pulse wave velocity were measured as surrogate markers of cardiovascular risk.

Results: LV mass was lowest in the normal BP group, whereas carotid-femoral pulse wave velocity and multiple measures of cardiac function were worse in the masked and ambulatory hypertensive groups. General linear models were constructed to examine the associations between BP phenotype and the cardiovascular risk measures. BP phenotype was significantly associated with diastolic function (E/e', e'/a'), systolic function (ejection fraction, peak longitudinal strain), and increased arterial stiffness after adjustment for body mass index percentile (all P ≤ .05).

Conclusions: BP phenotype is independently associated with surrogate markers of increased cardiovascular risk in adolescents, including impaired cardiac function and increased vascular stiffness. ABP monitoring has an important role in cardiovascular risk assessment in youth.

Keywords: ejection fraction; global longitudinal strain; heart; left ventricular hypertrophy.