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.

PROJECT NARRATIVE: Application of ambulatory blood pressure monitoring (ABPM) at an initial outpatient pediatric visit when the manual blood pressure measures above threshold may reduce time to hypertension diagnosis and attenuate the prevalence of hypertension underdiagnosis, particularly among youth residing within high deprivation communities. We assess the feasibility of ABPM placement at an initial outpatient, in-office pediatrician visit. We employ mixed-methods to assess provider, patient and parent response to this modified diagnostic strategy.