Faculty Bibliography

Objectives To describe the epidemiology of reclassification of prehypertensive and unclassified adolescents by 2022 American Heart Association (AHA) pediatric ambulatory blood pressure monitoring (ABPM) guidelines, and to evaluate the association of the new diagnostic categories with left ventricular hypertrophy (LVH). Study Design A single-center, retrospective review of ABPM reports from adolescents 13-21 years old, from 2015 through 2022, was performed. Adolescents with prehypertension or unclassified by 2014 guidelines were reclassified by 2022 definitions. Logistic regression models evaluated the association of reclassification phenotypes with LVH. Results A majority of prehypertensive adolescents reclassified to hypertension (70%, N=49/70). Over half (57%, N=28/49) of hypertension was isolated nocturnal hypertension, and 80% was systolic hypertension. Reclassification to hypertension was more common in males. The majority (55.6%) of unclassified adolescents were reclassified to normotension. No demographic or clinical variables were associated with reclassification categories. LVH was not associated with hypertension in the reclassified prehypertensive or unclassified groups. Conclusions The 2022 ABPM guidelines clearly define BP phenotypes. However, reclassification to hypertension was not associated with increased odds of LVH. As most prehypertensive adolescents reclassified as hypertensive by nighttime BPs alone, this study highlights the lowered threshold for nocturnal hypertension. Prospective studies in larger, well-defined cohorts are needed to describe better the predictive value of 2022 BP phenotypes for target organ damage.

Limited information is available regarding the relationship between ambulatory blood pressure monitoring (ABPM) and cardiac geometry in hypertensive children. ABPM and 2D-echocardiography were retrospectively reviewed in children and adolescents <21 years old with primary hypertension. A total of 119 participants (median age 15.0 [IQR 12, 16] years) with hypertension were included. Left ventricular hypertrophy was diagnosed in 39.5% of participants. Normal geometry was found in 47.1%, concentric remodeling (CR) in 13.4%, concentric hypertrophy (CH) in 15.1%, and eccentric hypertrophy (EH) in 24.4% of children. After adjustment for age, sex, and body mass index z-score, awake systolic blood pressure (BP) index (BPi) (OR 1.07, 95% CI: 1.001-1.14, P = 0.045), awake diastolic BPi (OR 1.04, 95% CI: 1.00-1.09, P = 0.048), awake systolic BP load (OR 1.02, 95% CI: 1.000-1.04, P = 0.047), and sleep systolic BP load (OR 1.02, 95% CI: 1.001-1.04, P = 0.03) were directly associated with CH. No ABPM parameters were significant predictors of EH. In conclusion, ABPM parameters were found to be independent predictors of cardiac geometry, specifically CH.

Anterior cruciate ligament (ACL) rupture is a significant injury in National Football League (NFL) quarterbacks. The purpose of this study was to determine (1) return-to-sport (RTS) rate in NFL quarterbacks following ACL reconstruction, (2) performance upon RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Thirteen quarterbacks (14 knees) who met inclusion criteria underwent ACL reconstruction while in the NFL. Matched controls were selected from the NFL during the same time span to compare and analyze age, body mass index (BMI), position, performance, and NFL experience. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Twelve quarterbacks (13 knees; 92%) were able to RTS in the NFL. Mean player age was 27.2±2.39 years. Mean career length in the NFL following ACL reconstruction was 4.85±2.7 years. Only 1 player needed revision ACL reconstruction. In both cases and controls, player performance was not significantly different from preinjury performance after ACL reconstruction (or index year in controls). There was also no significant performance difference between case and control quarterbacks following ACL reconstruction (or index year in controls). There is a high rate of RTS in the NFL following ACL reconstruction. In-game performance following ACL reconstruction was not significantly different from preinjury or from controls.