Low-renin essential hypertension—another form of childhood hypertension

Gruskin, Alan B.; Linshaw, Michael A.; Cote, Mary L.; Fleisher, Daniel S.

doi:10.1016/s0022-3476(71)80346-3

Cited by 17 publications

(4 citation statements)

References 33 publications

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“…In fact, primary hypertension was not described in the pediatric age group until 1971, when Gruskin and colleagues reported a 5-year-old girl with significantly elevated BP and a completely negative evaluation for secondary causes of hypertension [1]. Thus, at least until recently, primary hypertension has been considered a diagnosis of exclusion in children, and most recommendations for the evaluation of childhood hypertension still state that this diagnosis should only be made after an extensive evaluation for secondary causes, especially in younger children [2].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of children with primary hypertension seen at a referral center

2005

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Primary hypertension is well known to occur in children, but the characteristics of such children are changing due to the influence of the obesity epidemic. In view of this, we conducted a cross-sectional study of 70 children [age 13.3+/-4 years (mean +/- SD)] with primary hypertension referred to a specialized pediatric hypertension clinic. Secondary hypertension had been excluded after a standardized diagnostic evaluation. Isolated systolic hypertension was present in 62.9% of subjects. Family history of hypertension was present in 86.2%, and 52.9% were obese (BMI > or =95th percentile). BMI was weakly correlated with systolic BP (r =0.28,P =0.10) and was significantly correlated with total cholesterol (r =0.36,P =0.005) and triglycerides (r =0.42,P =0.01). Mean plasma renin activity (PRA) was 3.1+/-2.7 ng/ml/h. PRA was correlated with diastolic but not systolic BP. Patients with high PRA had higher diastolic BP and lower BMI compared to those with low PRA. Left ventricular hypertrophy was present in 24%. Mean 24-h systolic BP load by ambulatory BP monitoring was 52+/-24%; mean 24-h diastolic BP load was 18+/-16%; BP loads were greater in patients with high PRA. These data suggest that primary hypertension in children is characterized by systolic BP elevation, positive family history and obesity. Hyperlipidemia accompanies primary hypertension in obese children, and left ventricular hypertrophy is common. Patients with high PRA have more severe BP elevation. Future studies should focus on further defining the pathophysiology of primary hypertension in children, including the roles of renin and insulin resistance, so that improved methods of prevention and treatment can be developed.

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Section: Introductionmentioning

confidence: 99%

Characteristics of children with primary hypertension seen at a referral center

2005

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“…9 Even in settings where BP is monitored in children, an abnormal BP for that child can go unrecognized. 15 Since the first reported occurrence of childhood-onset essential hypertension in 1971, 16 an increasing number of children are being diagnosed with it. [17][18][19][20][21][22][23][24][25][26] The prevalence of hypertension (primary and secondary) in screened children is reported between 4.5% 22,27 and 13% 28 In the pediatric population, where secondary causes for hypertension are more prevalent than in adults, the prevalence of essential hypertension remains unknown.…”

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confidence: 99%

Essential Hypertension vs. Secondary Hypertension Among Children

Gupta-Malhotra

Banker

Shete

et al. 2014

American Journal of Hypertension

181

102

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“…Furthermore, urinary concentrations of Ang-(1-7) were inversely correlated with blood pressure [97]. Regarding pediatric patients, a limited number of studies only evaluated the levels of PRA and the results are quite variable and occasionally inconclusive [6,71,[98][99][100], although some of them suggested that an abnormal RAS activation could be involved in different forms of hypertension [6,71,99,100]. Our research team has recently reported significant differences among circulating Ang II and Ang-(1-7) levels in pediatric patients with renovascular disease and essential hypertension [101].…”

Section: Clinical Studiesmentioning

confidence: 99%

“…In general, hypertension can be classified as secondary to an identifiable disease or as primary, also called essential or idiopathic, in which no obvious subjacent etiology can be detected [3][4][5]. In fact, primary hypertension was not reported in the pediatric age group until 1971, when Gruskin and collaborators published a case of a 5-year-old girl [6]. In fact, primary hypertension was not reported in the pediatric age group until 1971, when Gruskin and collaborators published a case of a 5-year-old girl [6].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Arterial Hypertension: Insights from Pediatric Studies

Silva¹

2006

CPR

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Blood pressure is the direct product of cardiac output and total peripheral resistance. Cardiac output is regulated by preload, myocardium contractility and heart rate, while total peripheral resistance depends on afterload and vessel elasticity. The maintenance of blood pressure within normal limits is influenced by neural, humoral and local control mechanisms, which have extensive and complex interactions, making difficult an individual analysis. Thus, isolated or combined disarrangements in these mechanisms can lead to the development of hypertension. Neural blood pressure regulation mainly depends on lower brain stem centers of cardiovascular control and the autonomous nervous system, integrating the cardiovascular reflexes. In regard to humoral mechanisms, several substances/ systems contribute for increasing blood pressure (Angiotensin II, circulating cathecolamines), while others can play a counterregulatory role [Angiotensin-(1-7), kallikrein-kinin system and natriuretic peptides]. Moreover, local factors, such as nitric oxide and endothelins, act as determinants of vascular resistance and as systemic or local modifiers of neural and humoral mechanisms. Recently, research has begun to disclose the mechanisms related to blood pressure regulation at cellular and molecular level. In this review, we discussed experimental and clinical evidence relating to regulatory mechanisms probably involved in the pathophysiology of arterial hypertension with insights from pediatric studies.

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Low-renin essential hypertension—another form of childhood hypertension

Cited by 17 publications

References 33 publications

Characteristics of children with primary hypertension seen at a referral center

Characteristics of children with primary hypertension seen at a referral center

Essential Hypertension vs. Secondary Hypertension Among Children

Pathophysiology of Arterial Hypertension: Insights from Pediatric Studies

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