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Influence of passive smoking on exercise blood pressure in 492 subjects aged 12-17 years
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Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e129–e131
in this population was 8.7% and 9.0%, respectively. Overweight presented high prevalence in both genders (22.9%), more sharply in boys (29.2%), compared to girls (18.1%) (p<0.01). Low current weight reached less than 4% of adolescents, with similar expression between genders. Mild low height occurred in approximately 6% of adolescents, with considerable predominance in females (7.9%) in regard to males (3.9%) (p<0.018). Higher office blood pressure frequency in boys (11.0%) when compared to girls (6.6%) (p¼0,029) was observed. Alterations in home blood pressure (3.8%) were significantly below those observed for office blood pressure (8.5%). Odds ratio for low height was 2.4 times higher among adolescents with low birth weight (CI 95%¼ 1.1-5.1; p¼0.027). In the multiple linear regression analysis, for each increase of 100g in birth weight, height increased by 0.28 cm (CI 95%¼ 0.18-0.37; p0.05). Initially, there was a positive linear relation of birth weight to body mass index and to waist circumference, however it was not statistically sustained in a significant manner after adjustment for confounding variables. In summary, birth weight may be a height predictor in adolescence, reinforcing the plausibility of fetal programming. On the other hand, the absence of correlation between birth weight and overweight, abdominal adiposity and high blood pressure emphasized the relevance of post-natal factors in the explanation of these outcomes.
Keywords: birthweight; height; blood pressure; nutritional status P-232 Influence of passive smoking on exercise blood pressure in 492 subjects aged 12-17 years Claudia Hacke, Burkhard Weisser. Christian-Albrechts-University, Kiel, Germany Hypertension is one of the most important cardiovascular risk factor. There are many associations of smoking and blood pressure (BP) regulation. Even parental smoking seems to influence their children’s resting BP. In the present study, the influence of passive smoking on exercise BP of young subjects (aged 12-17 years) was investigated. In the Kiel EX.PRESS. (EXercise and PRESSure) study, the exercise BP of 492 young subjects was studied using a standardized cycle ergometer test. BP was measured at 1.5 Watt / kg body weight. The smoking status of mother and father was collected in a questionnaire. 22% of the mothers and 24% of the fathers of our participants were smokers. In 35% of the families investigated, there was at least one smoking parent. There was no influence of passive smoking on resting BP. In contrast, systolic exercise BP was significantly higher (6.3 mmHg, p¼0.001) in subjects exposed to passive smoking (153.4 17.3 vs. 147.1 17.3 mmHg). This difference was independent of age, height and sex. Parental Smoking independently affected systolic BP during exercise even after correction for fitness (physical working capacity 170) and BMI (151.9 16.5 vs. 147.9 16.3 mmHg, p¼0.03). After
adjustment according to parental educational level, the effect of passive smoking on exercise BP was no longer significant.To our knowledge, this is the first study demonstrating an effect of parental smoking on the exercise BP of their children. There was no effect on resting BP. At least in adults, exercise BP seems to correlate more closely with cardiovascular prognosis as with resting BP. Further research is needed to differentiate the impact of passive smoking and educational level on BP, since both a low social state and passive smoking seem to increase BP. Keywords: exercise blood pressure; passive smoking; adolescents P-233 Intravenous (IV) hydralazine in hypertensive pediatric inpatients: does it work? is it safe? Joseph Flynn,1 Miranda Bradford,2 Eric Harvey.1 1Seattle Children’s Hospital, Seattle, WA, United States; 2Seattle Children’s Research Institute, Seattle, WA, United States IV hydralazine, a direct vasodilator, is frequently administered to hypertensive pediatric inpatients, yet no data are available regarding its efficacy or safety in this population. We therefore queried the electronic medical record of Seattle Children’s Hospital to identify children who received IV hydralazine. Demographic and clinical data were retrospectively collected and then analyzed to determine the antihypertensive efficacy of IV hydralazine and to identify any safety concerns. Means and 95% confidence intervals for % change in blood pressure (BP) were calculated. Bivariate and multivariate linear regression was used to investigate associations between % BP change and age, gender, BP pre-hydralazine administration, hydralazine dose, administration of other antihypertensives, and diagnosis. Bivariate logistic regression was used to investigate associations between the same covariates and clinical response (CR), defined as 10-25% reduction in mean arterial pressure (MAP). 141 first doses of IV hydralazine given over 17 months were analyzed. Median age was 8 years (range 0-24); diagnoses included organ transplant (n¼39), renal disease (29), malignancy (29), respiratory failure (8), cardiac disease (8) and other (34). 76 children were receiving other antihypertensives at the time of hydralazine administration. The median dose of IV hydralazine was 0.10 mg/kg [range, 0.02-0.37]. The mean MAP reduction was 19% [standard deviation 12%]. A CR occurred in 66 patients (47%); of these, 60 received a single hydralazine dose, 5 received 2 doses, and 1 received 3 doses before achieving CR . A 2nd dose of hydralazine was administered within 6h of the 1st dose in 35 children because of insufficient response or increased BP. Higher initial MAP and increased hydralazine dose were associated with greater % decrease in MAP. No association was found between CR and age, gender, hydralazine dose, administration of other antihypertensives, or diagnosis; higher initial MAP was associated with greater odds of CR. Four adverse effects possibly related to IV hydralazine were recorded; 2 of these were episodes of hypotension. A >25% reduction in MAP occurred in 44 children (31%). Among this group, higher initial MAP and higher hydralazine dose were associated with increased odds of >25% MAP reduction, while administration of other antihypertensive drugs was associated with decreased odds of >25% MAP reduction. IV hydralazine reduced BP in the majority of children. However, a substantial proportion of children experienced potentially excessive BP reduction. A prospective study of IV hydralazine is needed to better define the dosing of this agent in the management of hypertension in hospitalized children. Keywords: children; adolescents; hydralazine; hypertensive emergency P-234 Intravenous hydralazine for blood pressure in the hospitalized child: its use is often unjustified? Julie Ostrye,4,1 Jenna Jones,3 Katherine Chessman,4 Brent Egan,3 Susan Hailpern,2 Ibrahim F. Shatat.4 1CCHMC, Cincinnati, OH, United States; 2Independent Consultant, Saratoga, CA, United States; 3MUSC,
Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e129–e131
in this population was 8.7% and 9.0%, respectively. Overweight presented high prevalence in both genders (22.9%), more sharply in boys (29.2%), compared to girls (18.1%) (p<0.01). Low current weight reached less than 4% of adolescents, with similar expression between genders. Mild low height occurred in approximately 6% of adolescents, with considerable predominance in females (7.9%) in regard to males (3.9%) (p<0.018). Higher office blood pressure frequency in boys (11.0%) when compared to girls (6.6%) (p¼0,029) was observed. Alterations in home blood pressure (3.8%) were significantly below those observed for office blood pressure (8.5%). Odds ratio for low height was 2.4 times higher among adolescents with low birth weight (CI 95%¼ 1.1-5.1; p¼0.027). In the multiple linear regression analysis, for each increase of 100g in birth weight, height increased by 0.28 cm (CI 95%¼ 0.18-0.37; p0.05). Initially, there was a positive linear relation of birth weight to body mass index and to waist circumference, however it was not statistically sustained in a significant manner after adjustment for confounding variables. In summary, birth weight may be a height predictor in adolescence, reinforcing the plausibility of fetal programming. On the other hand, the absence of correlation between birth weight and overweight, abdominal adiposity and high blood pressure emphasized the relevance of post-natal factors in the explanation of these outcomes.
Keywords: birthweight; height; blood pressure; nutritional status P-232 Influence of passive smoking on exercise blood pressure in 492 subjects aged 12-17 years Claudia Hacke, Burkhard Weisser. Christian-Albrechts-University, Kiel, Germany Hypertension is one of the most important cardiovascular risk factor. There are many associations of smoking and blood pressure (BP) regulation. Even parental smoking seems to influence their children’s resting BP. In the present study, the influence of passive smoking on exercise BP of young subjects (aged 12-17 years) was investigated. In the Kiel EX.PRESS. (EXercise and PRESSure) study, the exercise BP of 492 young subjects was studied using a standardized cycle ergometer test. BP was measured at 1.5 Watt / kg body weight. The smoking status of mother and father was collected in a questionnaire. 22% of the mothers and 24% of the fathers of our participants were smokers. In 35% of the families investigated, there was at least one smoking parent. There was no influence of passive smoking on resting BP. In contrast, systolic exercise BP was significantly higher (6.3 mmHg, p¼0.001) in subjects exposed to passive smoking (153.4 17.3 vs. 147.1 17.3 mmHg). This difference was independent of age, height and sex. Parental Smoking independently affected systolic BP during exercise even after correction for fitness (physical working capacity 170) and BMI (151.9 16.5 vs. 147.9 16.3 mmHg, p¼0.03). After
adjustment according to parental educational level, the effect of passive smoking on exercise BP was no longer significant.To our knowledge, this is the first study demonstrating an effect of parental smoking on the exercise BP of their children. There was no effect on resting BP. At least in adults, exercise BP seems to correlate more closely with cardiovascular prognosis as with resting BP. Further research is needed to differentiate the impact of passive smoking and educational level on BP, since both a low social state and passive smoking seem to increase BP. Keywords: exercise blood pressure; passive smoking; adolescents P-233 Intravenous (IV) hydralazine in hypertensive pediatric inpatients: does it work? is it safe? Joseph Flynn,1 Miranda Bradford,2 Eric Harvey.1 1Seattle Children’s Hospital, Seattle, WA, United States; 2Seattle Children’s Research Institute, Seattle, WA, United States IV hydralazine, a direct vasodilator, is frequently administered to hypertensive pediatric inpatients, yet no data are available regarding its efficacy or safety in this population. We therefore queried the electronic medical record of Seattle Children’s Hospital to identify children who received IV hydralazine. Demographic and clinical data were retrospectively collected and then analyzed to determine the antihypertensive efficacy of IV hydralazine and to identify any safety concerns. Means and 95% confidence intervals for % change in blood pressure (BP) were calculated. Bivariate and multivariate linear regression was used to investigate associations between % BP change and age, gender, BP pre-hydralazine administration, hydralazine dose, administration of other antihypertensives, and diagnosis. Bivariate logistic regression was used to investigate associations between the same covariates and clinical response (CR), defined as 10-25% reduction in mean arterial pressure (MAP). 141 first doses of IV hydralazine given over 17 months were analyzed. Median age was 8 years (range 0-24); diagnoses included organ transplant (n¼39), renal disease (29), malignancy (29), respiratory failure (8), cardiac disease (8) and other (34). 76 children were receiving other antihypertensives at the time of hydralazine administration. The median dose of IV hydralazine was 0.10 mg/kg [range, 0.02-0.37]. The mean MAP reduction was 19% [standard deviation 12%]. A CR occurred in 66 patients (47%); of these, 60 received a single hydralazine dose, 5 received 2 doses, and 1 received 3 doses before achieving CR . A 2nd dose of hydralazine was administered within 6h of the 1st dose in 35 children because of insufficient response or increased BP. Higher initial MAP and increased hydralazine dose were associated with greater % decrease in MAP. No association was found between CR and age, gender, hydralazine dose, administration of other antihypertensives, or diagnosis; higher initial MAP was associated with greater odds of CR. Four adverse effects possibly related to IV hydralazine were recorded; 2 of these were episodes of hypotension. A >25% reduction in MAP occurred in 44 children (31%). Among this group, higher initial MAP and higher hydralazine dose were associated with increased odds of >25% MAP reduction, while administration of other antihypertensive drugs was associated with decreased odds of >25% MAP reduction. IV hydralazine reduced BP in the majority of children. However, a substantial proportion of children experienced potentially excessive BP reduction. A prospective study of IV hydralazine is needed to better define the dosing of this agent in the management of hypertension in hospitalized children. Keywords: children; adolescents; hydralazine; hypertensive emergency P-234 Intravenous hydralazine for blood pressure in the hospitalized child: its use is often unjustified? Julie Ostrye,4,1 Jenna Jones,3 Katherine Chessman,4 Brent Egan,3 Susan Hailpern,2 Ibrahim F. Shatat.4 1CCHMC, Cincinnati, OH, United States; 2Independent Consultant, Saratoga, CA, United States; 3MUSC,