Ambulatory blood pressure variability in prediction of target organ injury: the SHIP AHOY study
Coral D Hanevold1, Jang Dong Seo2, Stephen R Daniels3
1Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. coral.hanevold@gmail.com.
Insights
Ambulatory blood pressure (BP) variability, particularly in diastolic BP and heart rate, helps predict subclinical cardiovascular damage like left ventricular hypertrophy in adolescents. Adding BP variability measures enhances risk identification beyond mean BP alone.
Area of Science:
- Cardiology
- Pediatric Hypertension
- Vascular Physiology
Background:
- Ambulatory hypertension in adolescents is linked to adverse cardiac remodeling and arterial stiffness.
- Current prediction of subclinical cardiovascular target organ damage (TOD) primarily relies on mean blood pressure (BP) measures.
- The added value of BP variability in predicting TOD in adolescents remains unclear.
Purpose of the Study:
- To determine if ambulatory BP (ABP) variability measures improve the prediction of subclinical cardiovascular target organ damage (TOD) in adolescents compared to mean ABP.
- To assess the association between different measures of ABP variability and indicators of TOD.
Main Methods:
- 397 adolescents underwent assessment of clinic and ambulatory BP (ABP), anthropometrics, and TOD.
- ABP variability was quantified using standard deviation and coefficient of variability (CV).
- TOD measures included left ventricular mass index (LVMI), left ventricular hypertrophy (LVH), and pulse wave velocity. General linear models analyzed determinants of TOD.
Main Results:
- Increased awake coefficient of variability for diastolic BP (CV-DBP) and heart rate (HR) dipping were significant predictors of LVMI.
- CV-HR independently predicted diastolic dysfunction but not systolic dysfunction.
- The combination of awake/asleep diastolic ABP variability and awake systolic ABP percentile improved prediction of LVH.
Conclusions:
- Ambulatory BP variability, beyond mean BP, is a significant factor in identifying adolescents at risk for cardiovascular target organ damage.
- Incorporating ABP variability measures may enhance early detection and management of subclinical TOD in pediatric populations.
- Further research can refine the use of ABP variability for risk stratification in adolescents.
Background:
Ambulatory hypertension is associated with elevated left ventricular mass index (LVMI), cardiac dysfunction, and increased arterial stiffness in adolescents. Whether the addition of measures of BP variability improves the prediction of subclinical cardiovascular target organ damage (TOD) over mean BP measures is not known.
Methods:
We assessed clinic and ambulatory BP (ABP), anthropometrics, and TOD in 397 adolescents. ABP means standard deviation (SD), BP, and heart rate (HR) dipping were calculated; coefficients of variability (CV) were calculated (SD/mean) to assess ABP variabilities. Measures of TOD included LVMI, left ventricular hypertrophy (LVH), LV systolic shortening, LV diastolic function (e'/a'), and pulse wave velocity. General linear models were used to determine if increased ABP variability measures were significant determinants of TOD in models containing mean ABP percentiles, age, sex, race/ethnicity, BMI z-score, and HR.
Results:
Mean participant age was 15.6 ± 1.7 years (63% white, 59% male) with mean casual BP 122.6/71.6 mmHg ±12.4/10.5, and mean awake systolic ABP 124.2/72.0 ± 11.3/7.7 mmHg. In linear models, increased awake CV-DBP and HR dipping were significant determinants of LVMI. CV-HR was an independent determinant of diastolic (e'/a') but not systolic dysfunction. Using logistic regression, the combination of awake and asleep diastolic ABP variability and awake systolic ABP percentile improved the prediction of LVH.
Conclusions:
Consideration of ABP variability in addition to ABP percentile may aid in identifying adolescents at risk for LVH.
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