74 - Association of Gestational Age and Birth Weight with Hypertension Severity and Adverse Cardiac Changes in Youth with Primary Hypertension

Poster Number: 74
Publication Number: 74.324

Carol Vincent, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Ashton Chen, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Andrew M. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: Hypertension (HTN) increases the risk of future cardiovascular disease beginning in childhood. Even in the young, multiple mechanisms likely contribute to HTN development. Early-life risk factors such as preterm birth can program future HTN in part by altering key cardiovascular biochemical pathways such as serum uric acid (SUA). In youth with primary HTN, how these pathways vary and whether gestational age (GA) and birthweight (BW) are associated with disease severity is not well known.

Objective: Determine the associations of GA, BW, and BW z-score with blood pressure (BP) severity, left ventricular mass index (LVMI), and SUA in youth with primary HTN.

Design/Methods: This is a secondary analysis of baseline data from a pilot prospective cohort study of youth aged 5–17 years with newly diagnosed primary HTN per AAP Clinical Practice Guideline criteria. Exclusion criteria were secondary HTN, diabetes mellitus, chronic kidney disease, heart disease, or non-English or Spanish speaker. Patient characteristics were recorded including age, race, ethnicity, gender, and biometrics. Our exposures were GA and BW by caregiver report and calculated BW z-scores. Our outcomes were BP and calculated BP z-scores, LVMI indexed to height2.7 and body surface area, left ventricular hypertrophy by AAP Clinical Practice Guideline criteria, and SUA. We estimated the associations between the exposures and outcomes using unadjusted generalized linear models.

Results: Of the 29 participants, mean age was 13.1 years (SD 3.6) with 31% female, 28% Black or African American, and 38% of Hispanic or Spanish origin ethnicity (Table 1). Mean GA was 39 weeks [IQR 36, 40] with 28% born preterm. Mean BW was 3110 g (SD 661) with 17% having low BW. No participants had left ventricular hypertrophy. In the unadjusted analysis, GA, BW, and BW z-score were not significantly associated with BP, LVMI, or SUA (Table 2).Conclusion(s): We did not observe associations between early-life exposures GA, BW, or BW z-score and BP severity, adverse cardiac changes, or SUA in youth with new-onset primary HTN. Our findings could reflect a small sample size with insufficient power or that these early-life factors do not confer substantive risk among all youth with primary HTN. Alternatively, these factors may increase risk of developing HTN but not HTN severity once established. Ongoing analyses include multivariable models and completing the study’s primary aims of investigating associations of the renin-angiotensin system and klotho with cardiovascular health indices, including epicardial fat thickness.
Carol Vincent CVCVincent CV 2022.pdf
Table 2: Unadjusted model results of the associations between gestational age at birth, birthweight, and birthweight z-score with blood pressure, left ventricular mass index, and serum uric acid in youth with primary hypertension at baseline