Feasibility and Acceptance of Early Ambulatory Blood Pressure Monitoring (ABPM) for Enhanced Pediatric Hypertension Diagnosis within a High Deprivation Community

项目总结/摘要： 该提案探讨了一种新的方法来诊断青年高血压（HTN）。我们调查的 门诊儿科医生首次使用动态血压监测装置的可行性 对生活在社会和经济贫困社区的青年进行快速诊断。我们 评估ABPM器械放置的可行性以及提供者、父母和患者在此阶段对ABPM的接受程度 初次访问。我们将使用20台INBRE已购买的ABPM器械。ABPM器械放置将在 一家儿科诊所儿科诊所位于一个高度社会和经济贫困的地区， 位于特拉华州的威尔明顿。ABPM将在10岁以下青少年的首次门诊儿科访视时提供 至18岁，当测量的初始手动BP高于阈值时（例如，收缩压> 130 mmHg和/或舒张压> 80 mmHg）。目前，青年HTN诊断充满了 诊断不足的挑战，加上需要多次访问的耗时算法。我们 满足重要的临床需求，包括及时诊断和及时临床干预， HTN青少年。该补编还采用了混合方法， 访谈以评估提供者、患者和父母对这种修改的诊断策略的反应。该提案是一项 对1个积极资助的INBRE提案和1个积极资助的COBRE的补充。按照《公约》的目标， 本补充，本科生将在研究设计，ABPM放置和报告， 青年HTN诊断指南建议，负责任的研究行为，数据输入，定性 访谈、数据分析和介绍调查结果。该补充是2个经验丰富的INBRE的共同努力 和COBRE资助的研究人员，Carissa Baker-Smith博士（儿科心脏病专家，儿科主任） 预防心脏病学）和埃里卡苏德博士（心理学家）。这个项目将为今后的工作打下基础。 传播和实施临床决策支持工具，结合早期放置ABPM 改善HTN诊断的设备。早期引入高血压疾病减毒干预策略 如果早期诊断，年轻人是可能的。

PROJECT SUMMARY/ABSTRACT: This proposal investigates a novel approach to hypertension (HTN) diagnosis in youth. We investigate the feasibility of ambulatory blood pressure monitoring (ABPM) device placement at an initial outpatient pediatrician visit for expediated diagnosis of HTN in youth living within socially and economically deprived communities. We assess the feasibility of ABPM device placement and provider, parent, and patient acceptance of ABPM at this initial visit. We will use 20 INBRE already purchased ABPM devices. ABPM device placement will occur within a single pediatric practice. The pediatric practice is located within a high socially and economically deprived community in Wilmington, Delaware. The ABPM will be offered at an initial outpatient pediatric visit in youth 10 to 18 years of age, when initial manual BP measured is above threshold (e.g., systolic blood pressure > 130mmHg and/or diastolic blood pressure > 80mmHg). Currently, HTN diagnosis in youth is fraught with the challenges of underdiagnosis, compounded by time-consuming algorithms that require multiple visits. We address a significant clinical need encompassing timely diagnosis and prompt clinical intervention for adolescents with HTN. The supplement also employs a mixed-methods approach and applies qualitative interview to assess provider, patient and parent response to this modified diagnostic strategy. The proposal is a supplement to 1 actively funded INBRE proposal and 1 actively funded COBRE. In accordance with the goals of this supplement, an undergraduate student will be trained in research design, ABPM placement and reporting, guideline recommendations for HTN diagnosis in youth, responsible conduct of research, data entry, qualitative interview, data analysis and presentation of findings. The supplement is the joint effort of 2 experienced INBRE and COBRE funded investigators, Dr. Carissa Baker-Smith (pediatric cardiologist, director of Pediatric Preventive Cardiology) and Dr. Erica Sood (psychologist). This project will lay the groundwork for future dissemination and implementation of a clinical decision support tool combined with earlier placement of ABPM device to improve HTN diagnosis. Earlier introduction of hypertensive disease attenuating intervention strategies in youth is possible if diagnosis is made earlier.