Hemodynamic Patterns and Target Organ Damage in Adolescents With Ambulatory Prehypertension

Obrycki, Łukasz; Feber, Janusz; Dereziński, Tadeusz; Lewandowska, Weronika; Kułaga, Zbigniew; Litwin, Mieczysław

doi:10.1161/hypertensionaha.119.14149

Cited by 40 publications

(34 citation statements)

References 43 publications

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“…However, average BMI in adolescents with blood pressure above the 90th percentile was at the 86th percentile. Similarly, in our study, 29% of adolescents with PH were obese and 53% were overweight [29]. Analysis of body composition with the use of dual X-ray densitometry (DXA) showed that the relation between adipose mass and lean body mass is disturbed in hypertensive adolescents [30].…”

Section: Body Compositionsupporting

confidence: 69%

Obesity, metabolic syndrome, and primary hypertension

2020

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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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Section: Body Compositionsupporting

confidence: 69%

Obesity, metabolic syndrome, and primary hypertension

2020

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“…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]. Although subjects included in our study had normal cSBP values, they were above median values [17].…”

Section: Discussionsupporting

confidence: 72%

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

et al. 2020

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Background The clinical significance of isolated systolic hypertension with normal central blood pressure known as spurious hypertension (sHT) in adolescents and its evolution over time is not known. Methods The aim of this study was to analyze changes in office, ambulatory blood pressure (ABPM), central systolic blood pressure (cSBP), hemodynamic parameters, and target organ damage (TOD) over a 1-year follow-up in a group of non-obese children with sHT. Results Of 294 patients referred for primary hypertension, 138 patients (31 girls; 22%) had hypertension confirmed by ABPM. 48/138 (35%) patients (7 girls; 15%) were diagnosed with sHT (elevated office and ambulatory systolic BP, but normal cSBP); 43 of them (6 girls; 14%) were followed for 12 ± 3 months during non-pharmacological therapy. At baseline 7 (16%) patients had borderline values of cIMT or LVMi indicating mild TOD. After 12 months, 10/43 (3 girls; 23%) patients developed sustained HT (elevated office, ambulatory BP and cSBP), 11/43 (1 girl; 26%) maintained sHT, and 22/43 (2 girls; 51%) evolved to white coat hypertension or normotension. The cSBP values increased in 27 patients (4 girls; 63%), but the group average remained in the normal range. Prevalence of TOD did not change during observation. The multivariate regression analysis showed that the only predictor of cSBP change over time was a change in serum uric acid level. Conclusions In conclusion, after 1 year of non-pharmacological treatment, 23% of adolescents with sHT developed sustained hypertension, with the main predictor of cSBP change being the change in serum uric acid.

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“…Z-cIMT was positively associated with Z-BMI, an association that was maintained after adjusting for age, sex, and cardiovascular risk factors ( 30 ). Another recent paper on children found that 24-h systolic BP, but not cSBP, is linked to Z-cIMT in the multivariate regression analysis ( 31 ). The same study found an association between cSBP and LVH in children similar to the data coming from Litwin and colleagues ( 32 ), but again the subject included in the studies were hypertensive children.…”

Section: Discussionmentioning

confidence: 99%

Central Systolic Blood Pressure Is Associated With Early Vascular Damage in Children and Adolescents With Type 1 Diabetes

Tagetti

Piona

Marcon

et al. 2021

Front. Cardiovasc. Med.

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Objective of the study: This study aimed to test the effect of multiple cardiovascular risk factors on subclinical indices of atherosclerosis in children and adolescents with type 1 diabetes (T1D).Methods: Carotid intima-media thickness (cIMT), carotid distensibility coefficient (cDC), and carotid–femoral pulse wave velocity (PWV) were measured in children and adolescents with T1D, in a follow-up at the outpatient clinics of Verona. Blood pressure (BP; both central and peripheral), metabolic and other cardiovascular risk factors were evaluated in multivariate linear regressions to assess the association with the measured indices of subclinical vascular damage.Results: One hundred and twenty-six children and adolescents were included. cIMT was above the 95th percentile for age and height in 60.8% of the population, whereas 26% of the sample had cDC impairment (less than the 5th percentile) and 4.8% had an elevated PWV. Independent determinants of cIMT according to the regression models were only gender type of glucose monitoring and central systolic BP (cSBP). PWV was associated with age, sex, heart rate, and cSBP; cDC with age and both cSBP and, alternatively, peripheral BP (pBP). Neither pBP nor any of the tested metabolic parameters, including glycated hemoglobin, was associated with PWV and cIMT.Conclusions: A high proportion of early vascular damage, especially an increased cIMT, is present in children and adolescents with T1D in whom cSBP seems to be a common determinant. In children and adolescents with T1DM, a special focus should be on hemodynamic risk factors beyond metabolic ones.

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Hemodynamic Patterns and Target Organ Damage in Adolescents With Ambulatory Prehypertension

Cited by 40 publications

References 43 publications

Obesity, metabolic syndrome, and primary hypertension

Obesity, metabolic syndrome, and primary hypertension

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

Central Systolic Blood Pressure Is Associated With Early Vascular Damage in Children and Adolescents With Type 1 Diabetes

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