Improving Cardiovascular Futures Through Timely Identification and Management of Hypertension in Youth

About This Grant

PROJECT ABSTRACT Cardiovascular disease risk trajectories begin in childhood and the need for prevention efforts to take a life course approach is clear. Yet, efforts to identify and manage cardiovascular risk factors in youth including hypertension, which impacts 1.3 million youth, are limited. This Mentored Research Scientist Development Award (K01) supports the training and research of Dr. Goulding, an Assistant Professor at UMass Chan Medical School. As a behavioral epidemiologist and applied public health researcher, Dr. Goulding’s long-term career goal is to build an empirical basis for the implementation of evidence-based practices and interventions to promote optimal cardiovascular health in youth. In support of this goal, this award provides training and mentorship through which Dr. Goulding will obtain the expertise and skills to develop behavioral interventions and implementation strategies and to design, conduct, and evaluate trials investigating them. Additionally she will gain understanding of clinical cardiovascular health management in youth and advance her leadership skillset. Training activities include didactic coursework, seminars, conferences, and experiential learning supported by a transdisciplinary mentorship team with expertise in behavioral and implementation sciences, prevention, pediatrics, biostatistics, and research trials. A clinical advisory board with expertise in pediatrics and hypertension, community based nursing, and health informatics will also guide the research. Youth with hypertension have 2-3 times greater risk of adverse cardiovascular outcomes including stroke and myocardial infarction in adulthood. The American Academy of Pediatrics has clinical practice guidelines recommending regular blood pressure screening and follow-up in youth to combat this risk. However, most cases of pediatric hypertension are not diagnosed due to a lack of recommended follow-up after high blood pressure screenings. This K01 research will support Dr. Goulding to co-develop and pilot a pediatric clinic-based implementation program, BP-Link, to increase adherence to clinical practice guidelines for follow-up blood pressure screenings. Based on Dr. Goulding’s prior research, BP-Link will include electronic health record changes, parent education and a menu of follow-up options. In Aim 1, we will use a stakeholder engaged implementation mapping approach to refine and co-develop the BP-Link implementation program. We will then pilot BP-Link in pediatric clinics using a parallel cluster randomized design. In Aim 2, we will use convergent mixed-methods to evaluate process outcomes from clinic providers, clinic support staff, and parent perspectives. Lastly, in Aim 3 we will establish feasibility for a full scale trial by evaluating BP-Link’s protocol and by using electronic health record data to explore child-level effectiveness outcomes. This work will inform a fully powered trial of BP-Link, a scalable implementation program with promise to improve cardiovascular health across the lifespan through early identification and subsequent management of pediatric hypertension. The research, training, and mentorship of this K01 are pivotal to Dr. Goulding’s development as an independent research scientist.