Intima-media thickness and arterial elasticity in hypertensive children: controlled study

Abstract

The objective of this cross-sectional controlled study was to evaluate the intima-media thickness (IMT) of the common carotid artery (cIMT) and superficial femoral artery (fIMT), as well as the elastic properties of the common carotid artery, in children with essential arterial hypertension. The study included 49 children with newly detected essential hypertension [mean age 14.5 (range 6-20) years] and 61 healthy normotensive children [mean age 13.5 (range 6-20) years]. The cIMT and fIMT were evaluated by ultrasonography. The elastic properties of the carotid artery were calculated from actual blood pressure values, arterial dimensions, and carotid wall thickness. Hypertensive children had greater values of both cIMT (0.45+/-0.05 mm) ( P=0.0001) and fIMT (0.37+/-0.05 mm) ( P=0.005) than controls (0.41+/-0.04 and 0.33+/-0.06 mm, respectively). The internal systolic and diastolic diameters of the common carotid artery were also significantly greater in hypertensive patients. The distensibility and elasticity of the common carotid artery were significantly decreased in hypertensive patients, while arterial compliance was significantly greater than in controls. cIMT and fIMT correlated with systolic and pulse pressure values, body mass index (BMI), homocysteine, low high-density lipoprotein, and apolipoprotein AI. After subdividing the control group and patients according to BMI below or above the 95th percentile for age and sex, there were differences only between normal-weight normotensive children and the two groups of hypertensive children. The stepwise regression analysis showed that the predictive factor for cIMT was pulse pressure and for fIMT body mass and homocysteine. Hence, in newly diagnosed children with essential hypertension, functional and anatomical changes in elastic and muscular arteries are observed. Pulse pressure and biochemical risk factors for cardiovascular damage were predictors of vessel wall injury, even if it remained within the normal range. BMI is an important factor influencing IMT values.

Effects of Childhood Primary Hypertension on Carotid Intima Media Thickness

“…Previous reports have controlled for this confounding effect of obesity by adjusting for BMI with multiple regression or by analyzing overweight and normal weight subjects separately, when comparing cIMT in hypertensive and normotensive groups. [12][13][14][15][16][17] Results have been variable, with some investigators reporting an association between childhood primary hypertension and increased cIMT 13 and others failing to find such an effect, after adjusting for BMI. 14 -17 Relationship between cIMT and daytime SBP index.…”

“…10,11 Recent studies have investigated whether cIMT is also increased in childhood primary hypertension. [12][13][14][15][16][17] However, these reports have been confounded by the high proportion of hypertensive subjects with obesity, itself an independent risk factor for increased cIMT. 18 -22 Consequently, after adjusting for body mass index (BMI), previous studies have been inconsistent in showing increased cIMT in hypertensive children and have failed to demonstrate office blood pressure (BP) as an independent predictor of cIMT.…”

Relationship between peritoneal permeability with inflammation and subclinical atherosclerosis in peritoneal dialysis patients

“…Increased CIMT, one of the first signs of early atherosclerosis, is related to high blood pressure, dyslipidemia, hyper-homocysteinemia and microinflammation (19,20). Elevated serum concentrations of CRP is another marker used to stratify CV risk by reflecting chronic inflammation in adult and pediatric CKD and dialysis patients (9,(21)(22)(23).…”

What Is the Significance of Increased Carotid Intima Media Thickness in Hypertensive Adolescents?

“…Similarly, Litwin et al, 7 in a study that included ambulatory blood pressure monitoring (ABPM), femoral and carotid IMT measurement, and assessments of biochemical parameters and vascular function in both normotensive and hypertensive subjects, found that vascular thickness was increased in hypertensive adolescents compared with controls and was associated with decreased vascular distensibility and elasticity. Vascular thickness correlated with systolic blood pressure and pulse pressure, as well as with some biochemical measures of cardiovascular risk, including homocysteine, highdensity lipoprotein, and apolipoprotein A1.…”

“…6,7 Increased cIMT is well established as a correlate of atherosclerosis in adults, typically occurring in conjunction with other cardiovascular risk factors. 8,9 In prospective studies, increased cIMT has been associated with increased rates of coronary heart disease events, especially in individuals with higher blood pressure, dyslipidemia, and cigarette smoking.…”