Hanevold Coral D, Seo Jang Dong, Daniels Stephen R, Falkner Bonita E, Ferguson Michael A, Flynn Joseph T, Ingelfinger Julie R, Khoury Philip R, Lande Marc B, Meyers Kevin E, Mitsnefes Mark, Samuels Joshua, Urbina Elaine M
Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Nephrol. 2025 May 19. doi: 10.1007/s00467-025-06803-4.
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.
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.
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.
Consideration of ABP variability in addition to ABP percentile may aid in identifying adolescents at risk for LVH.
动态高血压与青少年左心室质量指数（LVMI）升高、心脏功能障碍及动脉僵硬度增加有关。相较于平均血压测量值，增加血压变异性测量指标是否能改善对亚临床心血管靶器官损害（TOD）的预测尚不清楚。
我们评估了397名青少年的诊室血压和动态血压（ABP）、人体测量指标及TOD。计算ABP均值、标准差（SD）、血压及心率（HR）的下降情况；计算变异系数（CV）（SD/均值）以评估ABP变异性。TOD测量指标包括LVMI、左心室肥厚（LVH）、左心室收缩期缩短、左心室舒张功能（e'/a'）及脉搏波速度。使用一般线性模型来确定在包含平均ABP百分位数、年龄、性别、种族/族裔、BMI z评分及HR的模型中，增加的ABP变异性测量指标是否为TOD的显著决定因素。
参与者的平均年龄为15.6±1.7岁（63%为白人，59%为男性），平均偶测血压为122.6/71.6 mmHg±12.4/10.5，平均清醒收缩期ABP为124.2/72.0±11.3/7.7 mmHg。在线性模型中，清醒时CV-DBP增加及HR下降是LVMI的显著决定因素。CV-HR是舒张功能障碍（e'/a'）而非收缩功能障碍的独立决定因素。使用逻辑回归分析，清醒和睡眠时舒张期ABP变异性与清醒收缩期ABP百分位数的组合改善了对LVH的预测。
除ABP百分位数外，考虑ABP变异性可能有助于识别有LVH风险的青少年。
