Adolescent Blood Pressure Variation and Ventricular Mass
Adolescent Blood Pressure Variation and Ventricular Mass
To evaluate possible early neurogenic influence in essential hypertension by monitoring heart
 growth in adolescents over a two year interval.
BACKGROUND:

 Evidence has accumulated suggesting that essential hypertension begins early in life and is
 potentially preventable. One possible pathogenetic mechanism implicated is a sympathetic
 nervous system abnormality which is manifested by increased sympathetic drive to the heart.
 An elevated sympathetic nervous system tone and decreased vagal inhibition is responsible for
 the hyperkinetic circulation seen in a significant proportion of persons with borderline
 essential hypertension. Exaggerated blood pressure and heart rate responses to mental
 stressors have been documented in normotensive children of hypertensive parents. These
 changes appear to involve sympathetic over-responding to fight-flight stimuli.

 Increased blood pressure variability induced by stress might accelerate vascular and other
 changes leading to essential hypertension. Behavior and environment might chronically elevate
 sympathetic nervous system tone with damaging cardiovascular consequences. Stressful working
 conditions, defective anger management and poor interpersonal problem solving skills have
 been implicated in studies of stress-induced blood pressure increases. These influences may
 interact with diet and genetic risk to exacerbate pathophysiology. Essential hypertension
 risk might be reduced by modifying working and living environments and by training young
 persons at risk to cope with or avoid stressors that elicit defensive over-responding.

 DESIGN NARRATIVE:

 This longitudinal study tested two different models of sympathetic nervous system influence
 on the early pathophysiology of essential hypertension. The first neurogenic model was
 evaluated by determining whether an excessively variable or reactive blood pressure in year 1
 gave rise to excessive heart growth or left ventricular hypertrophy over a two year
 follow-up. The second neurogenic model was evaluated by determining if higher blood pressure
 exacerbated by personality, stress, and dietary sodium intake led to increased left
 ventricular hypertrophy at follow-up.

 All ninth-graders entering two large Baltimore high schools in year 1 and year 2 of the study
 were screened to yield the 240 subjects in the cohort. Initial screening included data on
 blood pressure, height, weight, health habits, personality, medical history, and health care
 utilization. Baseline exam included data on basal blood pressure, aerobic exercise stress,
 cognitive stress, interpersonal stress, ambulatory blood pressure, echocardiogram, physical
 activity, and Type A personality. The parents were also interviewed to assess family blood
 pressure status, health history, health care utilization and dietary habits including sodium
 intake. Students were re-examined at twelve and 24 months.

 The study completion date listed in this record was obtained from the "End Date" entered in
 the Protocol Registration and Results System (PRS) record.
No eligibility criteria