Cardiac and Vascular Target Organ Damage in Pediatric Hypertension

Abstract

Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.

Sex Differences in Association of Elevated Blood Pressure with Variables Characterizing Cardiometabolic Risk in Young Subjects with or Without Metabolic Abnormalities

“…Elevated BP (e.g., high normal BP (HNBP) and HT) associates with adverse cardiac and vascular changes such as increased left ventricular mass, carotid thickness, arterial stiffness, decreased diastolic function, and endothelial dysfunction, which are already found in children and adolescents [14]. It is well documented that overweight-associated or obesity-associated HNBP and HT is already in juveniles accompanied with worsened markers of cardiometabolic risk, e.g., with elevated total cholesterol, low-density lipoprotein cholesterol (LDL-C), triacylglycerols, fasting plasma insulin, C-reactive protein (CRP), uric acid, reduced high-density lipoprotein cholesterol (HDL-C), adiponectin, and insulin sensitivity [3,4,15].…”

Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls?

“…36 Pulse wave velocity is commonly used to assess arterial stiffness and shown to be increased as blood pressure increases. 37 Both pulse wave velocity and blood pressure are affected by height and age in children. 20,38 Most of the studies, evaluating pulse wave velocity in patients with coarctation of the aorta, have a heterogenous study population in terms of age including both adults and paediatric age groups.…”

“…Considering the higher left ventricular mass index even in children with normotension and the given importance of left ventricular hypertrophy as a risk factor for adulthood cardiovascular disease risk, all children with repaired coarctation of the aorta should be followed up lifelong and encouraged to establish a healthy lifestyle. Lastly, a clear blood pressure threshold at which the risk for cardiovascular events occurs, has not been defined for the general population, 37 or for the patients with repaired coarctation of the aorta patients. Therefore, as a future direction, prospective longitudinal studies, which evaluate blood pressure and surrogate markers of cardiovascular disease, are needed to answer the question of "Is there a need to target lower blood pressure percentiles for patients with repaired coarctation of the aorta without recoarctation to decrease cardiovascular disease risk?…”

Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children

“…LVM is an important measure of clinical prognosis and cTOD in childhood and offers insight into risk of CVD in early adulthood (43). LVM as a manifestation of cTOD is a powerful predictor of CVD risk in adults (47), particularly among African American adults (48).…”