Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review

Abstract

Adults with arterial hypertension (HTN) have stroke, myocardial infarction, end-stage renal disease (ESRD), or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes “hard outcomes” observed in adults. Left ventricular hypertrophy (LVH) or an anatomic and pathologic increase in left ventricular mass (LVM) in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered “the gold standard” for LVM and LVH determination, pediatric data are limited to “special populations”: ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.

Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients

“…LVH is a frequent finding in pediatric RT recipients ranging from 56% to 82%, but the definition of LVH varied between studies . Our study demonstrated that the prevalence of LVH after RT was 76.7% (23/30 patients), by using the definition from recently updated AAP guideline .…”

“…LVH has been used as an early surrogate outcome for cardiovascular risk in pediatric population . Consequently, adequate blood pressure control results in reduction of LVH prevalence and decreased LVMI …”

Commentary: Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review

“…Woroniecki and colleagues’ article on left ventricular hypertrophy (LVH) in pediatric hypertension (HTN) reviewed current definitions, clinically relevant methods of LVM measurements, and normalization methods as well as its epidemiology, management, and reversibility in children with HTN (1). …”

“…Woroniecki and colleagues’ article (1) exposed the puzzling concern of defining LVH in a pediatric population on the basis of the existence of diverse criteria with pros and cons. These arguments are not new and have contributed to the difficulty in recent years to ascertain a reliable standardization of LVH definition at the early stages of life in children and adolescents suffering from HTN.…”

“…Those topics are not mentioned in Woroniecki and colleagues’ article (1) and might be key to increasing the consistency of the assessment of HTN-related cardiac organ damage in children and adolescents.…”