Association of Blood Pressure Level With Left Ventricular Mass in Adolescents

Urbina, Elaine M.; Mendizábal, Brenda; Becker, Richard C.; Daniels, Steven R.; Falkner, Bonita; Hamdani, Gilad; Hanevold, Coral; Hooper, Stephen R.; Ingelfinger, Julie R.; Lanade, Marc; Martin, Lisa J.; Meyers, Kevin; Mitsnefes, Mark; Rosner, Bernard; Samuels, Joshua; Flynn, Joseph T.

doi:10.1161/hypertensionaha.119.13027

Cited by 89 publications

(68 citation statements)

References 43 publications

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“…However, there are different definitions for LVH (1,2,12,(17)(18)(19). In addition, LVH is not only affected by BP but also by age, sex, height, race, BMI, fat mass, and lean mass (20)(21)(22)(23). In our study, regression analysis revealed that the main predictors of LVMI z score were male sex, BMI z score, SBP, and PWV z score, explaining about 33.6% in concordance with literature.…”

Section: Discussionsupporting

confidence: 88%

Could arterial stiffness be early reversible target organ damage test in childhood hypertension?

Hacıhamdioğlu¹,

Ceylan²,

Yardımcı

2021

Anatolian J Cardiol

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Objective: The recommended treatment for hypertension (HTN) in children has been revised recently. This study aimed to present the changes in target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary HTN who were managed in accordance with the 2016 European Society of Hypertension Guidelines. Methods: Patients with primary HTN included in this study were newly diagnosed, untreated, and were followed-up for a minimum of 6 months. HTN was confirmed by 24-h ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, and first morning urine albumin tocreatinine ratio. The ABPM device performed measurements such as central blood pressure (cBP) and pulse wave velocity (PWV). Results: Thirty-two of 104 patients were enrolled. Seventeen patients were male, and 53% were obese. Compared with pretreatment, creatinine, urea, systolic BP (SBP), diastolic BP (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z score, cDBP, and PWV z score decreased, whereas LVMI and BMI z scores were unchanged. Conclusion: After BP improvement, while LVMI did not regress, the cSBP, cSBP z, and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of BP control on the cardiovascular system even in a short-term follow-up. Further longitudinal studies are needed for the assessment of BP control on arterial stiffness in childhood.

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Section: Discussionsupporting

confidence: 88%

Could arterial stiffness be early reversible target organ damage test in childhood hypertension?

Hacıhamdioğlu¹,

Ceylan²,

Yardımcı

2021

Anatolian J Cardiol

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“…In a cross-sectional study conducted in the USA, Flynn and Alderman reported that prehypertensive children were younger, their BMI values were lower, and the prevalence of obesity among them was 20%, while hypertensive children were older, their BMI was within the range of overweight, and the prevalence of obesity among them was 50% [27]. In a recent study, it was observed that BMI values increased with an increase in blood pressure status from below the 80th percentile, 80-90 to the > 90th percentile [28]. However, average BMI in adolescents with blood pressure above the 90th percentile was at the 86th percentile.…”

Section: Body Compositionmentioning

confidence: 98%

“…The tendency for elevated serum uric acid levels, even in the upper normal range (> 5.5 mg/dl), was found to be typical for adolescents with PH, and distinguished them from those with white-coat hypertension and secondary hypertension [47]. In a recent report from the SHIP-AHOY study, it was stated that the mean serum uric acid concentrations increased from 5.3 to 5.9 mg/dl with increasing blood pressure values from below the 80th to above the 90th percentile [28]. Moreover, Feig et al reported that allopurinol used in adolescents with PH and serum uric acid levels above 6 mg/dl lowered both the level of uric acid and blood pressure [48].…”

Section: Hyperuricaemia and Primary Hypertensionmentioning

confidence: 99%

Obesity, metabolic syndrome, and primary hypertension

Litwin

Kułaga

2020

Pediatr Nephrol

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Primary hypertension is the dominant form of arterial hypertension in adolescents. Disturbed body composition with, among other things, increased visceral fat deposition, accelerated biological maturation, metabolic abnormalities typical for metabolic syndrome, and increased adrenergic drive constitutes the intermediary phenotype of primary hypertension. Metabolic syndrome is observed in 15–20% of adolescents with primary hypertension. These features are also typical of obesity-related hypertension. Metabolic abnormalities and metabolic syndrome are closely associated with both the severity of hypertension and the risk of target organ damage. However, even though increased body mass index is the main determinant of blood pressure in the general population, not every hypertensive adolescent is obese and not every obese patient suffers from hypertension or metabolic abnormalities typical for metabolic syndrome. Thus, the concepts of metabolically healthy obesity, normal weight metabolically unhealthy, and metabolically unhealthy obese phenotypes have been developed. The risk of hypertension and hypertensive target organ damage increases with exposure to metabolic risk factors which are determined by disturbed body composition and visceral obesity. Due to the fact that both primary hypertension and obesity-related hypertension present similar pathogenesis, the principles of treatment are the same and are focused not only on lowering blood pressure, but also on normalizing body composition and metabolic abnormalities.

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“…Retinal vessel diameters are valid microvascular biomarkers shown to be associated with a higher risk of hypertension and obesity, incidence of stroke and myocardial infarction as well as higher cardiovascular mortality in adults (17,18). With elevated blood pressure not being benign in children and previously linked to target organ damage including increased carotid intima-media thickness (19) and left ventricular mass (20), this study will additionally explore the links with the retinal microvasculature as target organ damage marker in South African children. A previous study indicated that childhood obesity, high blood pressure, and physical inactivity were associated with retinal microvascular abnormalities, suggesting retinal vessel imaging as promising biomarkers for early risk stratification in children (21).…”

Section: Introductionmentioning

confidence: 99%

The Exercise, Arterial Modulation and Nutrition in Youth South Africa Study (ExAMIN Youth SA)

et al. 2020

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Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children.Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ∼1,000 primary school children (black and white boys and girls between ages 5-9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging. Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs. Trial registration:The study was retrospectively registered on ClinicalTrials.gov on 15 August 2019 (NCT04056377).

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Association of Blood Pressure Level With Left Ventricular Mass in Adolescents

Cited by 89 publications

References 43 publications

Could arterial stiffness be early reversible target organ damage test in childhood hypertension?

Could arterial stiffness be early reversible target organ damage test in childhood hypertension?

Obesity, metabolic syndrome, and primary hypertension

The Exercise, Arterial Modulation and Nutrition in Youth South Africa Study (ExAMIN Youth SA)

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