Abstract: FR-PO435
Improving Blood Pressure Control in Young Patients at Elevated Cardiovascular Risk: A Pilot Study
Session Information
- Pediatric Nephrology - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Seth, Divya, UCSF, University of California San Francisco, Division of Nephrology, San Francisco, California, United States
- Bicki, Alexandra, UCSF, University of California San Francisco, Division of Pediatric Nephrology, San Francisco, California, United States
- Sadiq, Sanober, UCSF, University of California San Francisco, Division of Pediatric Nephrology, San Francisco, California, United States
- Ku, Elaine, UCSF, University of California San Francisco, Division of Nephrology, San Francisco, California, United States
Background
Promoting physical activity can reduce the risk of cardiovascular disease, potentially lower systolic blood pressure (SBP), and help patients maintain an appropriate weight. We sought to determine if children and young adults with hypertension, diabetes, and/or chronic kidney disease can improve BP control through randomized assignment to a pedometer vs. usual care in a parallel arm crossover design trial.
Methods
Subjects from a single-center were randomized in a 2:1 ratio using a Fitbit Flex2 coupled with bimonthly study team feedback on step count. After 6 months, control subjects were crossed over to intervention (Figure 1). Change in SBP (primary outcome), weight and average weekly step count (secondary outcomes) were tracked every 3 months for 1 year and compared using mixed models.
Results
63 subjects enrolled (57% male, 48% Hispanic, 13% Black). Mean age was 18 ± 4 years and mean BMI z-score was 1.5 ± 0.95. Coupling provider feedback with self-monitored pedometer use did not result in a significant change in step count when comparing intervention to control. There was no change in unadjusted SBP or weight over time. When adjusted for age, sex, baseline SBP, and weight, the intervention arm showed a decline in SBP at Week 39, as compared to the control arm, but this change was not sustained at Week 52 (Table 1).
Conclusion
Pilot results suggest that self-monitored pedometer use, even with provider feedback, may not result in sustained improvement in BP, daily step count, or weight. Augmented interventions or alternative strategies to mitigate risk are needed.
| Follow-up | SBP in Intervention Median (IQR) | SBP in Control Median (IQR) | P-value for difference |
| Baseline | |||
| Week 13 | 121.8 (118.7, 125.0) | 120.1 (101.4, 138.7) | 0.96 |
| Week 26 | 122.9 (119.5, 126.4) | 124.2 (119.4, 129.0) | 0.66 |
| Week 39 | 120.6 (116.4, 124.8) | 128.5 (123.4, 133.6) | 0.02 |
| Week 52 | 120.2 (116.1, 124.2) | 123.7 (118.3, 129.2) | 0.30 |
Funding
- Other NIH Support