93 - Does Positive Emotion Play a Role in Blood Pressure Variability for Youth with Adverse Childhood Experiences: A Survey and EHR Data Linkage Study

Publication Number: 2089.93

Nia J. Heard-Garris, Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University, CHICAGO, IL, United States; Akram Ibrahim, Lurie Children’s Hospital, Chicago, IL, United States; Xuan Cai, Northwestern University, Chicago, IL, United States; Lina Saleh, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Mercedes Carnethon, Northwestern University, Chicago, IL, United States

Background: Blood pressure variability may serve as an early predictor for future cardiovascular disease (CVD) risk, with high variability associated with adverse cardiovascular events. This variability may be particularly detrimental for youth with early life trauma or adverse childhood experiences (ACEs), given their increased risk of CVD in later life. Yet, the relationship between ACEs and blood pressure variability among youth is understudied. Additionally, even less is known about potentially modifiable resilience factors, such as positive affect, within this relationship.

Objective: To examine the association between ACEs and blood pressure variability in youth and to determine if positive affect acts as an effect modifier.

Design/Methods: We conducted an online survey of youth from 3 pediatric clinics in Chicago, aged 13-20 of self-reported ACEs and emotional health. Survey responses were paired with systolic (SBP) and diastolic blood pressure (DBP) from electronic health records (EHR) and de-identified. ACEs were measured using the ACEs questionnaire, continuously and categorized into low (0-1), medium (2-3), and high (≥4) ACEs. Positive affect was measured using the Pediatric Positive Affect Short form (scores 8- 40), with higher scores indicating higher positive affect. Blood pressure variability was assessed by calculating standard deviation (SD), average real variability (ARV), and coefficient of variation (CV). The analysis included unadjusted and fully adjusted linear regression models, and trend testing across ACEs groups. Positive affect (PAF) was tested as an effect modifier, assessing interaction terms and conducting subgroup analyses using PAF median score.

Results: Participants (n=211) were 74% girls; median age, 16.2 ± 1.6 years old, with nearly half (49.7%) reporting ≥4 ACEs. Higher ACE score/category was associated with increased DBP variability but not SBP variability, across all measurements (all p-values < 0.05). PAF modified the association between ACEs and DBP variability. This was demonstrated by the interaction terms (all p values for interaction < 0.05) and subgroup analyses, where ACEs were associated with higher DBP variability in the PAF ≥27 (median) subgroup only (all p values < 0.05).

Conclusion(s): Higher ACE scores are associated with greater DBP variability among youth. This highlights the physiological impact of early adversity on cardiovascular health during adolescence. However, positive affect may act as a moderator, though closer examination is needed to determine if positive affect can be an intervention target for youth with ACEs to promote long-term cardiovascular health.

Table1. Participants Characteristics Overall and by ACE groups
ACEs and Blood Pressure Variance PAS abstract (AI edits)_XC_NHG_10_29_2025_TABLE 1.pdf

Table 2. Association of Blood Pressure Variability with Adverse Childhood Experiences
ACEs and Blood Pressure Variance PAS abstract (AI edits)_XC_NHG_10_29_2025_TABLE 2.pdfModel 01: Unadjusted model
Model 02: Model01 adjusted for demographic age, gender, race, ethnicity, and education
Model 03: Model02 adjusted for health factors obesity, and sleep duration


Graphic 1. Conceptual Model testing of Positive Affect (PAF) as an Effect Modifier on the relationship between Adverse Childhood Experiences (ACEs) and Diastolic Blood Pressure Variability (DBPV)
ACEs and Blood Pressure Variance PAS abstract (AI edits)_XC_NHG_10_29_2025_GRAPHIC 1.pdf