Blood Pressure Control in Young Patients at Elevated Cardiovascular Risk

The benefits of physical activity include reduction in the risk of cardiovascular disease, maintenance of an appropriate weight, and potentially lowering systolic blood pressure. Divya Seth, MD, and colleagues in the division of nephrology at the University of California San Francisco conducted a parallel arm crossover design trial to assess whether children and young adults with hypertension, diabetes, and/or chronic kidney disease (CKD) could improve blood pressure control via randomized assignment to a pedometer compared with usual care.

Results of the trial were reported during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled Improving Blood Pressure Control in Young Patients at Elevated Cardiovascular Rusk: A Pilot Study.

Participants at a single center were randomized 2:1 to the intervention group or the control group. Step count was measured using a Fitbit Flex 2 in combination with bimonthly study team feedback. After 6 months, participants in the control group were crossed over to the intervention group.

The primary outcome of interest was change in systolic blood pressure. Secondary outcomes included weight and average weekly step count. Outcomes were tracked every 3 months for 1 year. Mixed models were used to compare outcomes in the two groups.

The total cohort included 63 participants. Of those, 57% were male, 48% were Hispanic, and 13% were Black. Mean age was 18 years and mean body mass index z-score was 1.5.

In comparison of intervention to control, there was no significant change in step count when provider feedback was coupled with a self-monitored pedometer. There was no change in weight over time.

At week 39, following adjustment for age, sex, baseline systolic blood pressure, and weight, the intervention arm showed a decline in systolic blood pressure compared with the control arm. The change was not sustained at week 52.

“Pilot results suggest that self-monitored pedometer use, even with provider feedback, may not result in sustained improvement in blood pressure, daily step count, or weight,” the authors said. “Augmented interventions or alternative strategies to mitigate risk are needed.”

Source: Seth D, Bicki A, Sadiq S, Ku E. Improving blood pressure control in young patients at elevated cardiovascular risk: a pilot study. FR-PO435. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando, Florida.