1
|
Kaplinski M, Griffis H, Liu F, Tinker C, Laney NC, Mendoza M, Cohen MS, Meyers K, Natarajan SS. Left Ventricular Measurements and Strain in Pediatric Patients Evaluated for Systemic Hypertension and the Effect of Adequate Anti-hypertensive Treatment. Pediatr Cardiol 2022; 43:155-163. [PMID: 34426850 DOI: 10.1007/s00246-021-02706-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/08/2021] [Indexed: 11/24/2022]
Abstract
Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram and that these values would differ by weight, race, and HTN treatment. Data were collected from first visits to the HTN Program from 12/2011 to 9/2018, excluding patients with cardiac disease or heart transplantation. LV measurements including LV mass index (LVMI), LV GLS, and diastolic indices were compared between groups. Multivariable logistic regression was used to identify risk factors for an abnormal LVMI. There were 212 patients with an interquartile age range of 13-18 years. On univariate analysis, LVMI was higher in hypertensive, obese, and African American patients. LV strain was less negative in obese and African American patients. Adequately treated patients with HTN had a higher LVMI and a higher E/e' ratio compared to patients with no HTN. On multivariate analysis, only obesity was associated with an LVMI ≥ 95th percentile (OR 2.9, 95% CI 1.4, 5.8). LVMI is higher in hypertensive, obese, and African American patients; however, in the multivariate analysis, obesity was the only independent risk factor for an abnormal LVMI. LVMI was still higher in those adequately treated for HTN compared to patients without HTN, possibly due to concomitant obesity. Future studies should focus on subclinical changes in LV performance seen in obese and hypertensive patients and the impact on long-term health.
Collapse
Affiliation(s)
- Michelle Kaplinski
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Palo Alto, CA, 94340, USA.
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Fang Liu
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Tinker
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina C Laney
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Melodee Mendoza
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Meryl S Cohen
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Meyers
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Khoury M, Urbina EM. Hypertension in adolescents: diagnosis, treatment, and implications. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:357-366. [DOI: 10.1016/s2352-4642(20)30344-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
|
3
|
Min J, Griffis HM, Mendoza M, Tam V, Kaplinski M, Kogon AJ, Hanson H, Meyers KE, Natarajan SS. The Impact of Early Recognition and Treatment of Systemic Hypertension on Reducing Blood Pressure: The Hypertension and Vascular Evaluation Program. Clin Pediatr (Phila) 2020; 59:970-977. [PMID: 32476462 DOI: 10.1177/0009922820927037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the effect of an outpatient systemic hypertension program and associated factors with attending recommended follow-up visit. All visits were tracked in the program, 2011 to 2018. We examined patient characteristics by follow-up status and changes in systolic blood pressure (SBP) and the risk of hypertension in follow-up patients using a mixed-effects regression model. Among 310 patients with first visits, 113 patients returned for a follow-up visit. Patients who did not attend a follow-up were older and less likely to have a severe chronic condition or a family history of hypertension than followed-up patients. The risk of hypertension was significantly reduced by the number of follow-up visits (odds ratio = 0.53, 95% confidence interval = 0.31-0.92). Adolescent SBP and body mass index percentiles decreased with more follow-up visits. As the risk of hypertension is significantly reduced with follow-up visits, additional effort should be made to improve the likelihood of follow-up attendance.
Collapse
Affiliation(s)
- Jungwon Min
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather M Griffis
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melodee Mendoza
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vicky Tam
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Amy J Kogon
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, US
| | | | - Kevin E Meyers
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, US
| | - Shobha S Natarajan
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
4
|
Min J, Griffis HM, Tam V, Meyers KE, Natarajan SS. Association of neighborhood-level social determinants and food environments with pediatric hypertension care. Health Place 2020; 65:102383. [PMID: 32823141 DOI: 10.1016/j.healthplace.2020.102383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 01/22/2023]
Abstract
Despite the apparent relationship between neighborhood characteristics and health, few studies of child health address neighborhood-level barriers, which may contribute to clinic no-show rates and difficulties following treatment plans in children and youth. We used longitudinal data from an outpatient hypertension clinic to examine neighborhood social disorganization, built environments, and their associations with patients' clinic attendance and the risk of obesity/hypertension using mixed-effects regression models. Patients from disorganized neighborhoods were less likely to attend a baseline visit, and more likely to develop overweight/obesity and hypertension during follow-up. High-level fast-food expenditures in the neighborhood were associated with higher BMI percentiles and SBP during follow-up.
Collapse
Affiliation(s)
- Jungwon Min
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, USA.
| | - Heather M Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, USA
| | - Vicky Tam
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, USA
| | - Kevin E Meyers
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| |
Collapse
|