Central systolic blood pressure and central pulse pressure predict left ventricular hypertrophy in hypertensive children

Abstract

Background Central systolic and pulse pressures are stronger predictors of cardiovascular risk and hypertensive organ damage than brachial blood pressure. It is suggested that isolated systolic hypertension typically seen in adolescents is associated with normal central blood pressure and does not lead to organ damage and this phenomenon is called spurious hypertension. Methods We assessed the prevalence of spurious hypertension and analyzed utility of pulse wave analysis as determinant of hypertensive organ damage in 294 children (62 girls; 15.0 ± 2.4 years) diagnosed as primary hypertension. White coat hypertension, ambulatory prehypertension, ambulatory hypertension, and severe ambulatory hypertension were diagnosed in 127, 29, 41, and 97 patients, respectively. Results Normal central blood pressure was found in 100% in patients with white coat hypertension, 93% in pre-hypertensives, 51.2% in those with ambulatory hypertension, and 27.8% with severe ambulatory hypertension ( p = 0.0001). Children with severe ambulatory hypertension had higher central systolic and pulse pressure, pulse wave velocity, and greater prevalence of left ventricular hypertrophy than white coat and prehypertensive children ( p < 0.05). Left ventricular mass index and carotid intima-media thickness correlated with central systolic and pulse pressure ( p < 0.05 for all). Receiver operating curve area was similar for augmentation pressure (0.5836), 24-h ambulatory systolic blood pressure (0.5841), central systolic blood pressure (0.6090), and central pulse pressure (0.5611) as predictors of left ventricular hypertrophy. Conclusions These findings suggest that pulse wave analysis is complementary to ambulatory blood pressure monitoring in assessment of risk of organ damage in hypertensive adolescents.

Evolution of isolated systolic hypertension with normal central blood pressure in adolescents—prospective study

“…Because of the low number of subjects in each group, we did not find any statistically significant differences in sex distribution between those who maintained or normalized their BP status and those who increased cSBP, but numerically there were more females in the group which increased cSBP (9 vs. 30%, respectively). The 3 times higher percentage of females in the group which increased cSBP is in agreement with both our previous study (24.4%) and the overall sex distribution among adolescents with PH [9].…”

“…In contrast to our previous studies we did not find any changes in BMI or WC, both expressed in absolute and standardized values, as predictors of cSBP change. However, it must be underlined that subjects from this study had relatively normal BMI and WC values which were close to the median of the population norm (BMI-SDS and WC-SDS both below 1.0) and had lower BMI and WC than patients with ISH and elevated cSBP, as reported previously [9].…”

“…Mild TOD, mainly in the form of increased PWV was found in 7 of 43 (16%) patients at study start. As reported previously, patients with ISH and normal cSBP had lower prevalence of LVH and lower values of cIMT and PWV than those with elevated cSBP [9]. The finding of mild forms of TOD in subjects with brachial hypertension and normal cSBP is not surprising because cIMT and LVMi increase with change of blood pressure status from normotension to severe ambulatory hypertension and cSBP was found to be one of the predictors of LVMi [30].…”

Neutrophil to Lymphocyte Ratio is Increased and Associated with Left Ventricular Diastolic Function in Newly Diagnosed Essential Hypertension Children.

“…In this study, we found LVM and LVMI were both higher in hypertension children, and among 44 hypertension adolescents, 11.36% (5/44) of them had LVH. Similar, Litwin et al demonstrated 10.3% of 44 hypertension children had some form of LV hypertrophy in the USA population [25], and Falkner reported among 35 African-American adolescents, 19% of them had LV hypertrophy [26]. Also, a cross-sectional study of 101 primary hypertension children reported that 34% of them had LV hypertrophy [27].…”

Performance of the Vascular Stiffness Indicators and the Process of Left Ventricle Remodeling in Hypertensive Patients Under Renal Replacement Therapy

“…Оценка САД ао производилась путем построения кривой усредненной формы пульсации в восходящей аорте на основании кривой изменения давления в плечевой артерии с помощью прямого и обратного преобразования Фурье и передаточной функции, разработанной O'Rourke и соавторами на основании сопоставления прямого инвазивного измерения АД в аорте и плечевой артерии, а также с помощью заложенных в программе Vasotens математических алгоритмов [14]. В настоящее время не вызывает сомнения, что величина центрального АД лучше коррелирует с выраженностью гипертрофии левого желудочка (ГЛЖ) и сердечно-сосудистыми исходами [7,15,16]. В связи с чем ее определение является предпочтительным при ведении гипертензивных пациентов.…”