The prevalence of high blood pressure in children and young adults is increasing, yet there remains a large gap in our understanding of the optimal approach to blood pressure management in young individuals. Appropriate blood pressure control should be a priority for young patients with diabetes or chronic kidney disease who are at increased future risk for cardiovascular morbidity and mortality during adulthood. However, few longitudinal studies have examined the association between exposure to different blood pressure levels during youth and subsequent adverse cardiovascular or renal outcomes in later life. Improving the healthcare transition of adolescents with special healthcare needs has been identified as a priority of the American Academies of Pediatrics and Internal Medicine. The transition from adolescence into early adulthood represents a high-risk period for many individuals with chronic illnesses because of frequent non-adherence and suboptimal disease control. A better understanding of blood pressure trends during this period, associated outcomes, and effective interventions that will lower blood pressure in young populations at increased cardiovascular risk is needed to prevent the long-term sequelae of high blood pressure. Dr. Ku is establishing herself as a young investigator who is committed to patient-oriented research focused on hypertension in young populations. This is an initial submission for a K23 award which will provide Dr. Ku with the support necessary to accomplish the following goals: 1) to understand BP trends in patients receiving anti- hypertensive therapy during the transition from adolescence into adulthood and risks factors for elevated blood pressure during this period; 2) to study the association between different levels of blood pressure exposure and risk of adverse outcomes in young patients with diabetes or chronic kidney disease; 3) to investigate the feasibility of home BP monitor and physical activity tracker use as a means of lowering BP in young populations. This proposal will allow Dr. Ku to 1) perform hypertension research in a multi-disciplinary setting that integrates expertise from the fields of nephrology, cardiology, endocrinology, pediatrics, and transitional care; 2) gain hands-on experience in patient-oriented research, including primary data collection and analysis, trial design, and execution; 3) acquire advanced epidemiology and biostatistical expertise; and 4) set the platform for a career as an independent clinical investigator focused on interventional studies that will test alternate BP targets or home BP monitoring use in high-risk young populations. To achieve these goals, Dr. Ku has assembled a nationally-recognized mentoring team led by her primary mentor, Dr. Chi-yuan Hsu, Chief of the Division of Nephrology, and co-mentor, Dr. Kirsten Johansen, Professor of Medicine at University of California, San Francisco (UCSF). Dr. Ku's larger mentoring team also includes Dr. David Glidden, Professor of the Division of Biostatistics and Dr. Anthony Portale, Chief of the Division of Pediatric Nephrology at UCSF.

Public Health Relevance

Hypertension is common in young individuals with diabetes or chronic kidney disease. However, there is a paucity of data on the long-term outcomes associated with elevated blood pressure in children and young adults. This study will enhance our understanding of the risks factors and adverse outcomes that may associate with elevated blood pressure exposure during youth, and identify strategies that can be implemented to lower blood pressure in young populations to reduce future risk of cardiovascular morbidity and mortality.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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NHLBI Mentored Patient-Oriented Research Review Committee (MPOR)
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Einhorn, Paula T
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Ku, Elaine; Vittinghoff, Eric; Jacobs Jr, David R et al. (2018) Changes in Blood Pressure During Young Adulthood and Subsequent Kidney Function Decline: Findings From the Coronary Artery Risk Development in Young Adulthood (CARDIA) Study. Am J Kidney Dis 72:243-250
Ku, Elaine; McCulloch, Charles E; Warady, Bradley A et al. (2018) Twenty-Four-Hour Ambulatory Blood Pressure versus Clinic Blood Pressure Measurements and Risk of Adverse Outcomes in Children with CKD. Clin J Am Soc Nephrol 13:422-428
Ku, Elaine; Kopple, Joel D; Johansen, Kirsten L et al. (2018) Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality. Am J Kidney Dis 71:657-665
Ku, Elaine; Ix, Joachim H; Jamerson, Kenneth et al. (2018) Acute Declines in Renal Function during Intensive BP Lowering and Long-Term Risk of Death. J Am Soc Nephrol 29:2401-2408
Ku, Elaine; Scherzer, Rebecca; Odden, Michelle C et al. (2018) Patterns of blood pressure response during intensive BP lowering and clinical events: results from the secondary prevention of small subcortical strokes trial. Blood Press 27:73-81
Ku, Elaine; Kopple, Joel D; McCulloch, Charles E et al. (2018) Associations Between Weight Loss, Kidney Function Decline, and Risk of ESRD in the Chronic Kidney Disease in Children (CKiD) Cohort Study. Am J Kidney Dis 71:648-656
Winnicki, Erica; McCulloch, Charles E; Mitsnefes, Mark M et al. (2018) Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease. JAMA Pediatr 172:174-180
Ku, Elaine; Johansen, Kirsten L; McCulloch, Charles E (2018) Time-Centered Approach to Understanding Risk Factors for the Progression of CKD. Clin J Am Soc Nephrol 13:693-701
Ku, Elaine; Gassman, Jennifer; Appel, Lawrence J et al. (2017) BP Control and Long-Term Risk of ESRD and Mortality. J Am Soc Nephrol 28:671-677
Ku, Elaine; Bakris, George; Johansen, Kirsten L et al. (2017) Acute Declines in Renal Function during Intensive BP Lowering: Implications for Future ESRD Risk. J Am Soc Nephrol 28:2794-2801

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