5 - Association of sex with blood pressure severity, obesity, dyslipidemia, hyperglycemia, and target organ injury: a SUPERHERO interim analysis

Poster Number: 5
Publication Number: 5.321

Margaret Murphy, University of Kentucky College of Medicine, Lexington, KY, United States; John A. Bauer, University of Kentucky College of Medicine, Lexington, KY, United States; Shupti Biswas, Cohen Children's Medical Center, Floral Park, NY, United States; Aaron M. Bridges, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Wilkesboro, NC, United States; Lucy D'Agostino McGowan, Wake Forest University, Winston Salem, NC, United States; Victoria Giammattei, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, winston-Salem, NC, United States; Margret Kamel, Emory University School of Medicine, Atlanta, GA, United States; Stefan G. Kiessling, Kentucky Children's Hospital, Lexington, KY, United States; Jackson T. Londeree, Emory, Atlanta, GA, United States; Caroline B. Lucas, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Jason Misurac, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Sandeep Riar, Emory University School of Medicine, Atlanta, GA, United States; Christine Sethna, Cohen Children’s Medical Center, New Hyde Park, NY, United States; Irina Viviano, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Donald J. Weaver, Levine Children's Hospital, Charlotte, NC, United States; Ikuyo Yamaguchi, Oklahoma Childrens Hospital at OU Health, Oklahoma city, OK, United States; Emily J. Yun, Emory SOM, Atlanta, GA, United States; Andrew M.. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: Prevalence of obesity and other cardiovascular disease risk factors (i.e., hypertension (HTN), target organ injury (TOI), dyslipidemia, hyperglycemia) are increasing steadily in youth. Several studies have demonstrated that TOI is more prevalent in adult women, but this is unclear in youth.  

Objective: We hypothesized that female youth will have a greater risk of cardiovascular risk factors compared to males referred for HTN disorders.

Design/Methods: Analysis of baseline data from the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO) Registry, a multisite retrospective cohort of youth referred to subspecialty care for hypertension disorders using electronic health record data. Inclusion criteria were an initial subspecialty clinic visit for hypertension disorders identified by ICD-10 codes from 1/1/2015–12/31/2021 and age < 19 years. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. The exposure was sex. Outcome data included blood pressure with z-scores and classification, obesity by BMI or weight-for-length percentiles, and dyslipidemia, hyperglycemia, and TOI by ICD-10 codes. We used Welch two-sample t-test and unadjusted generalized linear models. 

Results: Of the 12,147 participants, 40% (n=4830) were female, 18% (n=2148) had stage 2 HTN, 48% (n=2313) had obesity, 2% (n=274) had dyslipidemia, 4% (n=439) had hyperglycemia, and 4% (n=474) had TOI. Female participants had higher DBP, SBP z-score, and DBP z-score with lower SBP compared to male participants. Female participants had a higher risk of hyperglycemia (RR 1.18, CI: 1.06 to 1.30) compared to males. No sex differences were observed for increased risk of severity of HTN, obesity, dyslipidemia, or TOI.  

Conclusion(s): In a large multisite cohort of youth referred for hypertension disorders, females had a greater risk for hyperglycemia and higher SBP and DBP z-scores compared to males.  This study supports the idea that sex may need to be incorporated into guidelines for the management and risk stratification of hypertension disorders in youth. It is likely that TOI is underreported through ICD-10 codes. Ongoing studies in this population are investigating associations between echocardiographic data and sex.