Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents

Objective: To analyze the influence of different number of blood pressure measurement on the detection of elevated blood pressure in Tibetan adolescents and provide scientific reference for standardizing the number of blood pressure measurement and accurately diagnosing elevated blood pressure in adolescents. Methods: Data were from the project "survey of the risk factors for elevated blood pressure among Tibetan adolescents" conducted from August to September 2018 in Shigatse in Tibet. A total of 2 822 Tibetan adolescents aged 12-17 years, including 1 275 boys (45.2%), were recruited by a convenient, stratified cluster sampling method. Each participant underwent three consecutive blood pressure measurements. Elevated blood pressure was defined according to the Health Industry Criterion of China: WS/T 610-2018 "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" . Analysis of variance and χ(2) test were used to analyze the effect of different blood pressure measurement on blood pressure levels and detection of elevated blood pressure, respectively. Results: SBP and DBP decreased substantially across three consecutive blood pressure measurements[SBP: (112.7±9.7), (110.7±9.7) and (110.2±9.5) mmHg (1 mmHg=0.133 kPa); DBP: (62.7±8.2), (61.1±8.5) and (60.6±8.5) mmHg; P value for trend<0.001]. The detection rates of elevated blood pressure based on three blood pressure measurements were 12.8%, 8.7% and 7.9%, respectively (P value for trend <0.001). Of note, the difference in the detection of elevated blood pressure based on the second blood pressure measurement or based on the average value of the second and third blood pressure measurements showed no significance (8.7% and 7.2%, P=0.039). Conclusions: Blood pressure levels and the detection of elevated blood pressure in adolescents decreased substantially across three consecutive blood pressure measurements. The second blood pressure measurement might be sufficient for screening elevated blood pressure in adolescents.

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We assessed whether insufficient sleep is associated with prehypertension in healthy adolescents. We undertook a cross-sectional analysis of 238 adolescents, all without sleep apnea or severe comorbidities. Participants underwent multiple-day wrist actigraphy at home to provide objective estimates of sleep patterns. In a clinical research facility, overnight polysomnography, anthropometry, and 9 blood pressure measurements over 2 days were made. Exposures were actigraphy-defined low weekday sleep efficiency, an objective measure of sleep quality (low sleep efficiency < or =85%), and short sleep duration (< or =6.5 hours). The main outcome was prehypertension (> or =90th percentile for age, sex, and height), with systolic and diastolic blood pressures as continuous measures as secondary outcomes. Prehypertension, low sleep efficiency, and short sleep duration occurred in 14%, 26%, and 11% of the sample, respectively. In unadjusted analyses, the odds of prehypertension increased 4.5-fold (95% CI, 2.1 to 9.7) in adolescents with low sleep efficiency and 2.8-fold (95% CI, 1.1 to 7.3) in those with short sleep. In analyses adjusted for sex, body mass index percentile, and socioeconomic status, the odds of prehypertension increased 3.5-fold (95% CI, 1.5. 8.0) for low sleep efficiency and 2.5-fold (95% CI, 0.9 to 6.9) for short sleep. Adjusted analyses showed that adolescents with low sleep efficiency had on average a 4.0+/-1.2-mm Hg higher systolic blood pressure than other children (P<0.01). Poor sleep quality is associated with prehypertension in healthy adolescents. Associations are not explained by socioeconomic status, obesity, sleep apnea, or known comorbidities, suggesting that inadequate sleep quality is associated with elevated blood pressure.

Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: Design of a pragmatic trial

To investigate the relationship between anthropometric parameters and elevated blood pressure in adolescents, we measured blood pressure (BP), height, weight, triceps skinfold (TSF) thickness, waist circumference (WC), and mid-upper-arm circumference (MUAC) in 2,860 student volunteers aged 11-17 years in Kayseri, Turkey. Waist-to-height ratio (WHtR), waist-to-arm-span ratio (WASR), body mass index (BMI), arm-fat area (AFA), and fat percentage (FP) were also calculated. Participants were divided into two groups: hypertensive [systolic blood pressure (SBP) or diastolic blood pressure (DBP) ≥ 95th percentiles, n = 246] and normotensives (SBP or DBP < 95th percentiles, n = 2614). Multiple logistic regression models were produced within these groups for the examined risk factors, and cutoff points were investigated for SBP or DBP ≥ 95th percentiles using receiver operating characteristics (ROC) analysis. BMI, WC, WHtR, WASR, MUAC, and BMI had statistically significant cutoffs among boys. Whereas BMI, WHtR, WASR, WC, MUAC, AFA, and TSF were statistically significant for girls younger than 15, only BMI and WC were statistically significant for participants older than 15. The independent risk factors for elevated BP were determined according to BMI and WC. Although several anthropometric measurements were significant in our participants, BMI and WC were significant among all participants irrespective of age and sex.

Variations in Levels of Blood Pressure: Of Prognostic Value or Not?

Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents. We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break. Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP (P interaction=0.007) and diastolic blood pressure (P interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP (P interaction=0.026) and diastolic blood pressure (P interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP (P interaction=0.034). A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.

It has been reported that adults suffering from refractory essential hypertension experience significantly fewer positive life events than healthy peers. However, the influence of positive life events on blood pressure (BP) in adolescents has been largely ignored. Therefore, we examined the relationship between self-reported positive life events and BP in 69 sixth graders with a mean age of 11.7 years. Positive life events were assessed with the Adolescent Perceived Events Scale and resting blood pressure was measured with a mercurial sphygmomanometer. Correlational analyses showed an inverse relationship between positive life events and diastolic BP, suggesting that adolescents experiencing more positive life events were more likely to have lower diastolic BP's. Hierarchical regression analyses revealed that physical activity level, dietary sodium-to-potassium ratio, parental history of hypertension, and measures of body composition predicted 24.6% of the variance in systolic BP and 34.6% of the variance in diastolic BP. Moreover, positive life events predicted an additional 4.3% of the variance in diastolic BP when statistically controlling these established risk factors for hypertension. These results suggest that increased perceptions of positive life events may act as a buffer to elevated BP in adolescents.

The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents

The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.

Birthweight, postnatal growth and blood pressure in adolescents of low socioeconomic condition: a cohort study in Northeast Brazil

Association between perfluoroalkyl substance concentrations and blood pressure in adolescents

Out-of-office blood pressure measurement in children and adolescents

Elevated blood pressure (BP) in adolescence has been linked to higher risk of cardiovascular disease mortality, as well as surrogate markers of atherosclerosis, such as carotid intima-media thickness and coronary artery calcification. However, these markers do not fully capture the complex spectrum of subclinical atherosclerotic cardiovascular disease. To examine the association between systolic and diastolic BP in adolescence and atherosclerosis in middle age, measured by coronary computed tomography angiography (CCTA). This population-based cohort study conducted in Sweden linked BP data from the Swedish Military Conscription Register (1972-1987) during adolescence to atherosclerosis data from the Swedish Cardiopulmonary Bioimage Study (2013-2018) during middle age. Data analyses were performed in May 2025. Adolescent BP was categorized according to the 2025 American College of Cardiology/American Heart Association (ACC/AHA) and the 2024 European Society of Cardiology (ESC) guidelines. The primary outcome was coronary atherosclerosis, evaluated via CCTA stenosis. The associations were analyzed using multinomial logistic regression, adjusted (marginal) prevalences, and restricted cubic splines. A total of 10 222 men with mean (SD) age of 18.3 (0.5) years at baseline and median (IQR) age of 57.8 (53.4-61.2) years at follow-up were included. At baseline, mean (SD) systolic BP (SBP) and diastolic BP (DBP) were 127.6 (10.7) mm Hg and 68.3 (9.5) mm Hg, respectively. After a median (IQR) follow-up of 39.5 (35.2-42.8) years, 4159 participants (45.7%) had 1% to 49% coronary stenosis and 784 (8.6%) had 50% or greater coronary stenosis. Elevated BP in adolescence was associated with coronary stenosis in a dose-response fashion. Adolescents with stage 2 hypertension had a higher risk of severe coronary stenosis (≥50%), with an odds ratio of 1.84 (95% CI, 1.40-2.42) and an adjusted prevalence of 10.1% (95% CI, 8.6%-11.5%) compared to those with normal BP (adjusted prevalence, 6.9%; 95% CI, 5.7%-8.1%). Elevated BP categories according to the 2025 ACC/AHA (120-129/<80 mm Hg) and the 2024 ESC (120-139/70-89 mm Hg) were associated with severe coronary atherosclerosis in middle age. The association was stronger for SBP than for DBP. In this population-based cohort study, higher BP levels in adolescence were associated with a dose-dependent higher risk for atherosclerosis in middle age, particularly for severe coronary atherosclerosis. Excess risks of atherosclerosis were even evident in the elevated BP range in adolescence as defined by the 2025 ACC/AHA and 2024 ESC BP guidelines.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools