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Robinson CH, Hussain J, Jeyakumar N, Smith G, Birken CS, Dart A, Dionne J, Garg A, Kandasamy S, Karam S, Marjerrison S, South AM, Thabane L, Wahi G, Zappitelli M, Chanchlani R. Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension. JAMA Pediatr 2024:2818399. [PMID: 38709137 DOI: 10.1001/jamapediatrics.2024.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Importance Hypertension affects 6% of all children, and its prevalence is increasing. Childhood hypertension tracks into adulthood and is associated with subclinical cardiovascular disease; however, there is a lack of evidence linking childhood hypertension to cardiovascular outcomes, which may contribute to underdiagnosis and undertreatment. Objective To determine the long-term associated risk of major adverse cardiac events (MACE) among children diagnosed with hypertension. Design, Setting, and Participants This was a population-based, retrospective, matched cohort study conducted from 1996 to 2022. The study included all children (aged 3-18 years) alive in Ontario, Canada, from 1996 to 2021, who were identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded. Exposure Incident hypertension diagnosis, identified by validated case definitions using diagnostic and physician billing claims. Each case was matched with 5 controls without hypertension by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension. Main Outcomes and Measures The primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention). Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression. Results A total of 25 605 children (median [IQR] age, 15 [11-17] years; 14 743 male [57.6%]) with hypertension were matched to 128 025 controls without hypertension. Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 1451 [5.7%] vs 7908 [6.2%]; congenital heart disease, 1089 [4.3%] vs 5408 [4.2%]; diabetes, 482 [1.9%] vs 2410 [1.9%]). During a median (IQR) of 13.6 (7.8-19.5) years of follow-up, incidence of MACE was 4.6 per 1000 person-years in children with hypertension vs 2.2 per 1000 person-years in controls (hazard ratio, 2.1; 95% CI, 1.9-2.2). Children with hypertension were at higher associated risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death, compared with nonhypertensive controls. Conclusions and Relevance Children diagnosed with hypertension had a higher associated long-term risk of MACE compared with controls without hypertension. Improved detection, follow-up, and control of pediatric hypertension may reduce the risk of adult cardiovascular disease.
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Affiliation(s)
- Cal H Robinson
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Junayd Hussain
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nivethika Jeyakumar
- Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
| | - Graham Smith
- Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anika Garg
- Infant, Child, and Youth Health Lab, Brock University, St Catharine's, Ontario, Canada
| | - Sujane Kandasamy
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sabine Karam
- Department of Medicine, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis
| | - Stacey Marjerrison
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew M South
- Department of Pediatrics, Brenner Children's, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Gita Wahi
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Michael Zappitelli
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Chanchlani
- ICES, Toronto, Ontario, Canada
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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2
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Leventoğlu E, Büyükkaragöz B, Sunar Yayla EN, Esmeray Şenol P, Bakkaloğlu SA. Arterial Stiffness and Ambulatory Blood Pressure Measurements in Children With Familial Mediterranean Fever. Clin Pediatr (Phila) 2023:99228231211705. [PMID: 37937548 DOI: 10.1177/00099228231211705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Familial Mediterranean fever (FMF) is an autoinflammatory disease which may cause endothelial dysfunction and arterial stiffness. In this study, we evaluated patients with FMF in terms of arterial stiffness indicators and investigated whether there was any difference according to colchicine response. This is a single-center, prospective, case-control study conducted on pediatric patients with FMF. Patients were categorized into 2 groups: patients on colchicine monotherapy (group 1) and patients who used anti-interleukin-1 (IL-1) plus colchicine (group 2). Patient age, mutations in the MEFV gene, overall duration of treatments, and general characteristics of symptoms were recorded. Laboratory values in an attack-free period were noted. Pulse wave velocity (PWV) was measured in all patients. Erythrocyte sedimentation rate and C-reactive protein, nocturnal hypertension, and PWV were higher in group 2. Arterial stiffness develops due to subclinical inflammation in patients with FMF. It is more pronounced in colchicine-resistant patients.
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Affiliation(s)
- Emre Leventoğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | | | - Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
- Department of Pediatric Rheumatology, Gazi University, Ankara, Turkey
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3
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Urbina EM, Daniels SR, Sinaiko AR. Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here? Hypertension 2023; 80:1572-1579. [PMID: 37278234 PMCID: PMC10524445 DOI: 10.1161/hypertensionaha.122.19455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The association between hypertension in adulthood and cardiovascular morbidity and death is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.
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Affiliation(s)
- Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati
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4
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Seeman T, Pfaff M, Sethna CB. Isolated nocturnal hypertension in pediatric kidney transplant recipients. Pediatr Transplant 2022; 26:e14192. [PMID: 34845793 DOI: 10.1111/petr.14192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Isolated nocturnal hypertension (INH) is defined as nighttime hypertension in the setting of normal daytime blood pressure (BP), diagnosed by ambulatory BP monitoring (ABPM). METHODS AND RESULTS Hypertension affects 60%-80% of pediatric kidney transplant recipients, and INH is the most common type of ambulatory hypertension. INH is associated with an increased prevalence of hypertension-mediated target organ damage such as left ventricular hypertrophy in adults and in pediatric kidney transplant recipients. CONCLUSION Ambulatory BP monitoring should be performed annually in all pediatric kidney transplant recipients to diagnose hypertension phenotypes that are not detectable by office BP such as masked hypertension, white-coat hypertension, or INH. Isolated nocturnal hypertension in pediatric transplant patients requires study as a treatment target.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Munich, Germany.,Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Mairead Pfaff
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Christine B Sethna
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.,Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA
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5
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High blood pressure in children and adolescents: current perspectives and strategies to improve future kidney and cardiovascular health. Kidney Int Rep 2022; 7:954-970. [PMID: 35570999 PMCID: PMC9091586 DOI: 10.1016/j.ekir.2022.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Hypertension is one of the most common causes of preventable death worldwide. The prevalence of pediatric hypertension has increased significantly in recent decades. The cause of this is likely multifactorial, related to increasing childhood obesity, high dietary sodium intake, sedentary lifestyles, perinatal factors, familial aggregation, socioeconomic factors, and ethnic blood pressure (BP) differences. Pediatric hypertension represents a major public health threat. Uncontrolled pediatric hypertension is associated with subclinical cardiovascular disease and adult-onset hypertension. In children with chronic kidney disease (CKD), hypertension is also a strong risk factor for progression to kidney failure. Despite these risks, current rates of pediatric BP screening, hypertension detection, treatment, and control remain suboptimal. Contributing to these shortcomings are the challenges of accurately measuring pediatric BP, limited access to validated pediatric equipment and hypertension specialists, complex interpretation of pediatric BP measurements, problematic normative BP data, and conflicting society guidelines for pediatric hypertension. To date, limited pediatric hypertension research has been conducted to help address these challenges. However, there are several promising signs in the field of pediatric hypertension. There is greater attention being drawn on the cardiovascular risks of pediatric hypertension, more emphasis on the need for childhood BP screening and management, new public health initiatives being implemented, and increasing research interest and funding. This article summarizes what is currently known about pediatric hypertension, the existing knowledge-practice gaps, and ongoing research aimed at improving future kidney and cardiovascular health.
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6
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Leventoğlu E, Pekçetin Şişik P, Çelik İE, Büyükkaragöz B. The effect of COVID-19 restriction on metabolic syndrome in primary hypertension. Pediatr Int 2022; 64:e15144. [PMID: 35831258 DOI: 10.1111/ped.15144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/28/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary hypertension (HT) has been increasingly reported in parallel to the increase in the prevalence of obesity in children, both of which are important components of metabolic syndrome. The aim of this study was to investigate the effects of COVID-19 restrictions, which are believed to induce lifestyle changes and physical inactivity, on the parameters of metabolic syndrome in children with primary hypertension. METHODS This was an observational, pre-post study conducted on pediatric patients with primary HT. The first phase of the study was the period prior to when COVID-19 restrictions were put in place in Turkey, and the second phase was up to the date when the restrictions were lifted. Anthropometric and blood pressure measurements, laboratory tests, and hypertensive-mediated organ damage at both phases of the study were compared. RESULTS Severe restrictions due to the COVID-19 pandemic were associated with an increase in mean ± standard deviation body mass index (BMI) (26.4 ± 7.3 vs. 27.2 ± 7.1, P = 0.002), antihypertensive drug use (n = 53 (57.6%) vs. n = 59 (64.1%), P < 0.0001), fasting blood glucose level (89.4 ± 12.6 vs. 94.1 ± 14.2, P = 0.013), and a borderline elevation in total cholesterol (21 [22.8%] vs. 28 [30.4%], P < 0.0001). These increases negatively affected end organs, with an increased frequency of interventricular septum hypertrophy (n = 12 [13%] vs. n = 17 [18.5%], P = 0.031). CONCLUSIONS COVID-19 restrictions were associated with an increased risk of parameters associated with metabolic syndrome in patients with primary hypertension. Physicians should carefully monitor the weight, blood pressure, fasting plasma glucose level, and total cholesterol levels in patients during periods of movement/activity restrictions such as during the COVID-19 pandemic.
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Affiliation(s)
- Emre Leventoğlu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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7
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Seeman T, Hradský O, Gilík J. Isolated nocturnal hypertension is associated with increased left ventricular mass index in children. Pediatr Nephrol 2021; 36:1543-1550. [PMID: 33411072 DOI: 10.1007/s00467-020-04861-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Isolated nocturnal hypertension (INH) is associated with increased prevalence of left ventricular hypertrophy (LVH) and cardiovascular morbidity and mortality in adult patients. Unlike in adults, data illustrating the possible association between INH and cardiac target organ damage is lacking in children. This study aimed to investigate whether INH is associated with increased left ventricular mass index (LVMI) and LVH in children. METHODS Retrospective data from all untreated children with confirmed ambulatory hypertension (HT) in our center was reviewed. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed concurrently. Ambulatory normotensive children served as controls. LVH was defined as LVMI ≥ 95th percentile. RESULTS There were 102 ABPM studies; of these, 79 children had renal HT, and 23 had primary HT. Median age of children was 13.2 years (3.8-18.9). Nineteen children had INH, 9 children had isolated daytime HT, 54 had daytime and nighttime HT, and 20 were normotensive. The LVMI adjusted for age (patient's LVMI/95th percentile of the LVMI) was significantly higher in children with INH than in normotensive children (0.83 ± 0.03 vs. 0.74 ± 0.03, p = 0.03). Left ventricular hypertrophy was present in 11% of children with INH; this was not significantly higher than in normotensive children (0%, p = 0.23). CONCLUSIONS This study investigated the association between INH and cardiac structure in children with primary and renal HT and showed children with INH had higher LVMI adjusted for age than normotensive children and children with INH had similar LVMI adjusted for age to children with isolated daytime HT.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, University Hospital Motol, Charles University Prague, Second Faculty of Medicine, V Úvalu 84, 15006, Prague, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University Prague, Pilsen, Czech Republic.
| | - Ondřej Hradský
- Department of Pediatrics, University Hospital Motol, Charles University Prague, Second Faculty of Medicine, V Úvalu 84, 15006, Prague, Czech Republic
| | - Jiří Gilík
- Kardiocentrum and Centre for Cardiovascular Research, University Hospital Motol, Prague, Czech Republic
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8
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Matjuda EN, Sewani-Rusike CR, Anye SNC, Engwa GA, Nkeh-Chungag BN. Relationship between High Blood Pressure and Microalbuminuria in Children Aged 6-9 Years in a South African Population. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E131. [PMID: 32906740 PMCID: PMC7552714 DOI: 10.3390/children7090131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Though the association between high blood pressure and microalbuminuria is well established in adults, there is a paucity of information on microalbuminuria in children. This study investigated the relationship between high blood pressure and microalbuminuria in 6-9-year-old children. A cross-sectional study, which included 306 primary school children of age 6-9 years old from urban areas (n = 154) and rural areas (n = 152) of the Eastern Cape Province of South Africa, was conducted. Participants' anthropometric data were determined and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured and converted to BP percentiles for age, sex and height. Creatinine and albumin concentrations were assayed in early morning midstream urine and the albumin to creatinine ratio (ACR) was calculated. There was a 42.8% prevalence of elevated blood pressure/high blood pressure (E-BP/H-BP) and a 10.1% prevalence of microalbuminuria. Among the 131 children with E-BP/H-BP, 17 had elevated ACR with a prevalence of 13.95%. SBP and HR increased with increasing range of ACR and, furthermore, SBP was significantly (p < 0.05) higher in children with moderately and severely increased ACR. SBP was associated with ACR and increased SBP predicted microalbuminuria (R2 = 0.42, adj R2 = 0.039, B: 0.120, p = < 0.05). In conclusion, microalbuminuria was present in 6-9-year-old South African children of African Ancestry and a weak association was observed with SBP in children.
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Affiliation(s)
- Edna Ngoakoana Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa; (E.N.M.); (C.R.S.-R.)
| | - Constance R. Sewani-Rusike
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa; (E.N.M.); (C.R.S.-R.)
| | - Samuel Nkeh Chungag Anye
- MBCHB Programme, Faculty of Health Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
| | - Benedicta Ngwechi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, 5117 Mthatha, South Africa;
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9
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Çakıcı EK, Yazılıtaş F, Kurt-Sukur ED, Güngör T, Çelikkaya E, Karakaya D, Bülbül M. Clinical assessment of primary and secondary hypertension in children and adolescents. Arch Pediatr 2020; 27:286-291. [PMID: 32682663 DOI: 10.1016/j.arcped.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Abstract
The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.
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Affiliation(s)
- E K Çakıcı
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey.
| | - F Yazılıtaş
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E D Kurt-Sukur
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - T Güngör
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E Çelikkaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - D Karakaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - M Bülbül
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
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10
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Affiliation(s)
- Coral D Hanevold
- From the Division of Nephrology, Seattle Children's Hospital, WA; and Department of Pediatrics, University of Washington School of Medicine, Seattle
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11
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Subclinical Organ Damage in Children and Adolescents with Hypertension: Current Guidelines and Beyond. High Blood Press Cardiovasc Prev 2019; 26:361-373. [PMID: 31650516 DOI: 10.1007/s40292-019-00345-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/10/2019] [Indexed: 01/20/2023] Open
Abstract
High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.
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12
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Watanabe M, Hikichi H, Fujiwara T, Honda Y, Yagi J, Homma H, Mashiko H, Nagao K, Okuyama M, Kawachi I. Disaster-related trauma and blood pressure among young children: a follow-up study after Great East Japan earthquake. Hypertens Res 2019; 42:1215-1222. [PMID: 30903093 DOI: 10.1038/s41440-019-0250-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022]
Abstract
The 11 March 2011 earthquake and tsunami in Japan resulted in ~19,000 lost lives and the displacement of nearly a quarter million people owing to extensive property damage and evacuation from the nuclear meltdown in Fukushima. We sought to prospectively examine whether exposure to disaster-related trauma affected blood pressure levels among young children. We sampled children in three affected prefectures (Miyagi, Fukushima, Iwate) and one unaffected prefecture (Mie). The participants (mean age 6.6 years) and their caregivers answered a baseline survey (N = 320) and a follow-up survey 4 years after the earthquake (N = 227, follow-up rate 71%). Disaster-related trauma was assessed at the baseline, and blood pressure measurements were taken at the follow-up. We converted blood pressure data into age/sex/height-specific z-scores. In linear regression models, we controlled for body mass index, income, age, sex, and housing situation (living in the same house as before the disaster, in a shelter, or in a new house). The number of traumatic experiences was related to diastolic blood pressure in a dose-dependent manner but was not related to systolic blood pressure. Children reporting four or more traumatic experiences had marginally significant elevated diastolic blood pressure (β = 0.43, p = 0.059). Among specific types of disaster trauma, witnessing a fire was significantly related to higher diastolic blood pressure (β = 0.60, p = 0.009). In conclusion, disaster-related trauma was associated with higher diastolic blood pressure among young children 4 years after the traumatic events.
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Affiliation(s)
- Masahiro Watanabe
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Hikichi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02125, USA
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yukiko Honda
- Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Junko Yagi
- Department of Psychiatry, Iwate Medical University, Iwate, Japan
| | | | | | | | - Makiko Okuyama
- Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Kawachi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02125, USA
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13
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Sethna CB, Kee D, Casado P, Murphy M, Palmer LS, Ghorayeb SR, Morganstern B. Renal sonographic changes in heterogeneity index and echogenicity in children with hypertension: a novel assessment. ACTA ACUST UNITED AC 2018; 12:e77-e83. [PMID: 30502313 DOI: 10.1016/j.jash.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/18/2018] [Accepted: 11/09/2018] [Indexed: 11/17/2022]
Abstract
The kidneys are thought to contribute to the pathogenesis of primary hypertension, but hypertension is also known to cause target organ damage in the kidney. Noninvasive methods to capture possible changes in the kidney related to hypertension are limited. A new program that has been used to quantify the heterogeneity and percent echogenicity in renal ultrasound images was implemented to assess patients with hypertension. Children and adolescents <21 years with primary hypertension diagnosed by ambulatory blood pressure monitoring were compared with normotensive age- and sex-matched controls. Renal ultrasound images were evaluated by a technique that measured pixels of gray-scale images and transformed them into a binary map, which was converted to a heterogeneity index (HI) and percent echogenicity score. This study included 99 children with hypertension and 99 control subjects. Body mass index (BMI) was greater in the hypertension group. Average HI for hypertension was significantly higher than in controls (1.37 ± 0.19 vs. 1.2 ± 0.23, P = .001), while echogenicity scores were not different (26.6 ± 8.9 vs. 25.9 ± 10, P = .8). In regression analysis adjusting for BMI z-score and race, hypertension was associated with greater HI compared with controls (β = 0.11, 95% confidence interval 0.03-0.18, P = .005). In a model adjusted for age, sex, and BMI z-score in the hypertension group only, no ambulatory blood pressure monitoring measures were associated with HI or echogenicity scores (P > .05).HI was significantly greater in the hypertension group compared with normotensive controls. HI may be a novel method to detect changes in the kidney related to hypertension.
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Affiliation(s)
- Christine B Sethna
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA.
| | - Dustin Kee
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Pablo Casado
- Ultrasound Research Lab, DeMatteis School of Engineering and Applied Sciences, Hofstra University, Hempstead, NY, USA
| | - Megan Murphy
- Ultrasound Research Lab, DeMatteis School of Engineering and Applied Sciences, Hofstra University, Hempstead, NY, USA
| | - Lane S Palmer
- Division of Pediatric Urology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sleiman R Ghorayeb
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA; Ultrasound Research Lab, DeMatteis School of Engineering and Applied Sciences, Hofstra University, Hempstead, NY, USA
| | - Bradley Morganstern
- Division of Pediatric Urology, Cohen Children's Medical Center, New Hyde Park, NY, USA
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14
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Yan Y, Zhang T, Li S, Liu Y, Bazzano L, He J, Mi J, Chen W. Black-White Difference in the Impact of Long-Term Blood Pressure From Childhood on Adult Renal Function: The Bogalusa Heart Study. Am J Hypertens 2018; 31:1300-1306. [PMID: 30010953 DOI: 10.1093/ajh/hpy109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To examine racial difference in the impact of long-term burden of blood pressure (BP) from childhood on adult renal function between middle-aged blacks and whites. METHODS The study cohort consisted of 1,646 whites and 866 blacks aged 20-51 years at follow-up who had BP measured at least 4 times since childhood, with a mean follow-up period of 25.3 years. The area under the curve (AUC) was calculated as a measure of long-term burden of BP from childhood to adulthood. Estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine to assess renal function in adulthood. RESULTS Black vs. white adults had significantly higher values of eGFR and long-term burden of systolic BP for both males and females. In multivariable linear regression analyses, adjusting for sex, adult age, body mass index, smoking, and alcohol use, adult eGFR was significantly and negatively associated with adult systolic BP (standardized regression coefficient [β] = -0.10, P = 0.005) and diastolic BP (β = -0.11, P = 0.003) in blacks, but not in whites. The total BP AUC values were also significantly and negatively associated with adult eGFR (β = -0.10, P = 0.005 for systolic BP and β = -0.09, P = 0.013 for diastolic BP) in blacks only. Childhood BP was not significantly associated with adult eGFR in blacks and whites. CONCLUSIONS These findings suggest that black-white disparities in the influence of elevated BP on the development of renal dysfunction occur in middle adulthood, which underscores the importance of BP control in the black population.
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Affiliation(s)
- Yinkun Yan
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Tao Zhang
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Shengxu Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yang Liu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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15
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Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018; 11:73-79. [PMID: 30519088 PMCID: PMC6233698 DOI: 10.2147/ibpc.s152761] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypertension is closely linked to increased cardiovascular risk and development of target organ damage (TOD). Therefore, proper clinical follow-up and treatment of hypertensive subjects are mandatory. A great number of individuals present a variation on blood pressure (BP) levels when they are assessed either in the office or in the out-of-office settings. This phenomenon is defined as white coat syndrome - a change in BP levels due to the presence of a physician or other health professional. In this context, the term "white coat syndrome" may refer to three important and different clinical conditions: 1) white coat hypertension, 2) white coat effect, and 3) masked hypertension. The development of TOD and the increased cardiovascular risk play different roles in these specific subgroups of white coat syndrome. Correct diagnose and clinical guidance are essential to improve the prognosis of these patients. The aim of this review was to elucidate contemporary aspects of these types of white coat syndrome on general and hypertensive population.
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Affiliation(s)
- Mariana R Pioli
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Alessandra Mv Ritter
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Ana Paula de Faria
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Rodrigo Modolo
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil, .,Laboratory of Cardiac Catheterization, Department of Internal Medicine, Cardiology Division, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
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16
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Sawamura LS, Souza GGD, Santos JDGD, Suano-Souza FI, Gessullo ADV, Sarni ROS. Albuminuria and glomerular filtration rate in obese children and adolescents. ACTA ACUST UNITED AC 2018; 41:193-199. [PMID: 30328467 PMCID: PMC6699442 DOI: 10.1590/2175-8239-jbn-2018-0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. METHOD Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. DATA COLLECTED weight, height, waist circumference and systemic arterial pressure. LABORATORY TESTS lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). RESULTS The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). CONCLUSION Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.
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Affiliation(s)
| | | | | | - Fabíola Isabel Suano-Souza
- Faculdade de Medicina do ABC, Departamento de Pediatria, Santo André, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brasil
| | - Anelise Del Vecchio Gessullo
- Faculdade de Medicina do ABC, Departamento de Pediatria, Santo André, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brasil
| | - Roseli Oselka Saccardo Sarni
- Faculdade de Medicina do ABC, Departamento de Pediatria, Santo André, SP, Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brasil
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17
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Radhakrishna V, Kumaravel S, Priyamvada PS, Hanumanthappa N, Jindal B, Govindarajan K, Naredi BK, Rijhwani A. Clinico-Biochemical Profile of Children with Congenital Anomalies of the Kidney and Urinary Tract: A Cross-Sectional Study. KIDNEY DISEASES 2018; 5:51-57. [PMID: 30815465 DOI: 10.1159/000493683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022]
Abstract
Background Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of disorders responsible for the majority of pediatric end-stage renal disease cases. There are only a few studies on CAKUT. Objectives A study was conducted to determine the clinical and biochemical profile of children with CAKUT and to estimate the prevalence and the factors associated with hypertension in CAKUT. Methods A cross-sectional study was conducted in a tertiary center for 18 months from March 2014 to August 2015. Demographic data were recorded, and clinical examination including blood pressure measurement was performed. Various biochemical parameters including plasma renin activity (PRA), urinary beta-2-microglobulin (B2M), and microalbuminuria were evaluated. Results A total of 81 patients with CAKUT were studied. Twenty-two (27%) patients were underweight, 4 (5%) patients were stunted, and 26 (32%) were both underweight and stunted. Children with bilateral disease had a higher incidence of underweight (21/44 vs. 8/37; p = 0.04; 95% CI; Fisher exact test), and both underweight and stunted (25/44 vs. 10/37; p = 0.006; 95% CI; Fisher exact test) compared to children with unilateral disease. Hypertension was found in 27% cases. No association was found between hypertension and PRA, BM2, or microalbuminuria in our study. PRA was inversely proportional to the estimated glomerular filtration rate (eGFR) (Pearson test; 95% CI; p = 0.006). Conclusions Bilateral disease in CAKUT was significantly associated with poor somatic growth. PRA was inversely proportional to eGFR. The prevalence of hypertension was higher in children with CAKUT than in normal children and is possibly multifactorial as it was not associated with elevated PRA, B2M, or microalbuminuria.
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Affiliation(s)
- Veerabhadra Radhakrishna
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sambandan Kumaravel
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | | | | | - Bibekanand Jindal
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Krishnakumar Govindarajan
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Bikash Kumar Naredi
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Ashok Rijhwani
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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18
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Pediatric Hypertension: Impact on the Heart, Brain, Kidney, and Retina. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Keshri S, Sharma S, Agrawal N, Bansal S, Guilliani BP, Aggrawal KC. Hypertension and its severity in children with steroid sensitive nephrotic syndrome during remission. Clin Exp Nephrol 2018; 22:1157-1162. [PMID: 29569147 DOI: 10.1007/s10157-018-1565-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypertension is not a typical feature of steroid sensitive nephrotic syndrome (SSNS) and the presence of persistent hypertension is suggestive of significant renal lesion. There is paucity of data regarding occurrence and severity of hypertension in SSNS in pediatric population during remission and was the main objective of this study. In addition, correlation with factors like family history, BMI, and lipid profile was studied. METHODS Cross-sectional study conducted at tertiary care center in India including 81 children of infrequent relapsing SSNS between 1 and 10 years in remission and was off steroids. Grading and severity of hypertension were assessed. Statistical analysis was done using SPSS version 21.0. RESULTS Median age of presentation was 5 years, with male:female ratio of 1.3:1. Out of 81 infrequent relapsing SSNS children, 23.45% (19) had hypertension. Among those children with hypertension (n = 19), 73.68% (14) had positive family history compared to 32.25% (20) in those without hypertension. Positive correlation was found between BP and serum cholesterol and LDL. Of the hypertensive patients, 1 (5.26%) had fundus changes, 2 (10.52%) had features of left ventricular hypertrophy, and 13 (68.42%) had non-nephrotic range proteinuria. CONCLUSION There is high incidence of hypertension in NS children during remission. Though significant positive correlation was found with positive family history of hypertension and deranged lipid profile highlighting possibility of essential hypertension in them, there is need for close active monitoring and management of hypertension in them as untreated cases may have significant target organ damage.
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Affiliation(s)
- Swasti Keshri
- Department of Pediatrics, VMMC and Safdarjung Hospital, Delhi, New Delhi, 110029, India
| | - Shobha Sharma
- Department of Pediatrics, VMMC and Safdarjung Hospital, Delhi, New Delhi, 110029, India. .,, 1228, Type IV (Special), R K Puram sec-12, Delhi, New Delhi, 110022, India.
| | - Neha Agrawal
- Department of Pediatrics, VMMC and Safdarjung Hospital, Delhi, New Delhi, 110029, India
| | - Sandeep Bansal
- Department of Cardiology, VMMC and Safdarjung Hospital, Delhi, New Delhi, 110029, India
| | - B P Guilliani
- Department of Ophthalmology, VMMC and Safdarjung Hospital, Delhi, New Delhi, 110029, India
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20
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Yang L, Yang L, Zhang Y, Xi B. Prevalence of Target Organ Damage in Chinese Hypertensive Children and Adolescents. Front Pediatr 2018; 6:333. [PMID: 30525012 PMCID: PMC6262348 DOI: 10.3389/fped.2018.00333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/16/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Subclinical target organ damage (TOD) has been common in hypertensive children, but there is limited data in the Chinese pediatric population. This study aimed to investigate the prevalence of subclinical TOD in the Chinese hypertensive children and adolescents. Methods: A cross-sectional study was performed in children and adolescents from four schools in Jinan, China between September 2012 and September 2014. The hypertensive status was confirmed based on elevated blood pressure across three different occasions. Those with hypertension were invited to participate in the evaluation of TOD (including heart, arteries, and kidney) and metabolic disorders. A total of 7,840 children and adolescents aged 6-17 years were recruited at baseline, of whom 373 were diagnosed as hypertensive after three separate visits, and 333 (89%) participated in evaluation of TOD. Results: Among 333 hypertensive children, 47.4% had elevated carotid intima-media thickness, 32.4% had left ventricular hypertrophy, 29.2% had dyslipidemia, 7.6% had liver dysfunction, and 4.1% had microalbuminuria. Cardiovascular damages were more prevalent in children aged 9-14 years than the other age groups (i.e., 6-8 and 15-17 years). Girls had higher proportion of microalbuminuria than boys (8.2 vs. 2.6%). No significant sex and age differences were observed for the prevalence of other TODs. Nearly all subclinical TODs were much more prevalent in hypertensive children who were overweight and obese than those with normal weight, except microalbuminuria. Conclusions: The subclinical TOD is prevalent in Chinese hypertensive children and adolescents. Effective measures should be taken to fight against subclinical TOD.
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Affiliation(s)
- Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Lili Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Yuanyuan Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
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21
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Flynn JT. High blood pressure in the young: why should we care? Acta Paediatr 2018; 107:14-19. [PMID: 28986990 DOI: 10.1111/apa.14110] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 01/19/2023]
Abstract
While primary hypertension (HTN) clearly occurs in children and adolescents, the approach of many providers to such patients can best be described as ambivalent: the condition may be recognised, but is not acted upon. Such ambivalence may stem from incomplete understanding of the effects of high blood pressure in the young, which in turn is related to the shortage of information on long-term outcomes of primary childhood HTN. However, other evidence on the short- and long-term effects of blood pressure elevation in childhood clearly shows that it is not a benign condition at all. CONCLUSION Childhood HTN warrants action to prevent adult cardiovascular disease.
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Affiliation(s)
- Joseph T. Flynn
- Pediatrics; University of Washington School of Medicine; Seattle WA USA
- Division of Nephrology; Seattle Children's Hospital; Seattle WA USA
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22
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1839] [Impact Index Per Article: 262.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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23
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Flynn JT. Microalbuminuria in Children With Primary Hypertension. J Clin Hypertens (Greenwich) 2016; 18:962-965. [PMID: 27259969 DOI: 10.1111/jch.12858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA.
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24
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Leiba A, Twig G, Levine H, Goldberger N, Afek A, Shamiss A, Derazne E, Tzur D, Haklai Z, Kark JD. Hypertension in late adolescence and cardiovascular mortality in midlife: a cohort study of 2.3 million 16- to 19-year-old examinees. Pediatr Nephrol 2016; 31:485-92. [PMID: 26508439 DOI: 10.1007/s00467-015-3240-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/03/2015] [Accepted: 09/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of early hypertension on midlife cardiovascular (CV) mortality remains controversial. We assessed the association of established hypertension in late adolescence with subsequent CV mortality. METHODS Of 2,298,130 Israeli adolescents (60% males; age 17.4 ± 0.3 years) who underwent a compulsory medical examination prior to military service between 1967 and 2010, 8720 teenagers (0.4%) were formally diagnosed with persistent hypertension. Using Cox proportional hazards modeling, we compared the hypertensive group to the large normotensive group with regard to time to event analysis of midlife mortality due to cerebrovascular accidents (CVA), coronary heart disease (CHD), sudden death (SD) and their summation as cardiovascular disease (CVD). RESULTS During 45,729,521 person-years of follow-up, we identified 2918 CV deaths-2879 and 39 among the 2,289,410 normotensive and 8720 hypertensive adolescents, respectively. Hypertension at a young age was associated with a threefold elevation of stroke mortality compared to normotension when adjusted for sex, age at examination, birth year, country of origin, socioeconomic status, education, body mass index (BMI) and height [hazard ratio (HR) 3.12; 95% confidence interval (CI) 1.76-5.54; p < 0.001]. There was no significant association of hypertension with CHD mortality or SD. An increased risk for overall CVD mortality among hypertensive youngsters (HR 1.51; 95 % CI 1.10-2.07) was attenuated after adjusting for BMI and other covariates (HR 1.24; 95% CI 0.90-1.72). CONCLUSIONS Established hypertension at a young age was independently associated with elevated stroke mortality in midlife. This finding warrants confirmatory large-scale long-term follow-up studies to address the distant effects of adolescent hypertension.
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Affiliation(s)
- Adi Leiba
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel. .,The Israel Defense Forces Medical Corps, Ramat Gan, Israel. .,Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
| | - Gilad Twig
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program and Department of Medicine B, Sheba Medical Center, Ramat Gan, Israel
| | - Hagai Levine
- Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | | | - Arnon Afek
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.,Israel Ministry of Health, Jerusalem, Israel
| | - Ari Shamiss
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Estela Derazne
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Dorit Tzur
- The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | | | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
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25
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Gupta-Malhotra M, Hamzeh RK, Poffenbarger T, McNiece-Redwine K, Hashmi SS. Myocardial Performance Index in Childhood Onset Essential Hypertension and White Coat Hypertension. Am J Hypertens 2016; 29:379-87. [PMID: 26271107 DOI: 10.1093/ajh/hpv123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/03/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND As a global measure of ventricular systolic and diastolic function, the myocardial performance index (MPI) can be an early indicator of hypertensive cardiomyopathy in children with essential hypertension (EH). METHODS Children with untreated newly diagnosed EH and white coat hypertension (WCH) by a 24-hour ambulatory blood pressure monitoring (ABPM), both groups without any identifiable etiology for the hypertension, were enrolled for the study. Echocardiograms and vascular ultrasounds for carotid artery intimal medial thickness were performed on all children prior to therapy. Diastolic function (peak E and A velocities, E/A ratio, isovolumic relaxation time, and deceleration times) and MPI were evaluated by simultaneous transmitral and transaortic spectral Doppler flow velocities. Systolic function was evaluated by shortening fraction and ejection fraction. RESULTS A cohort of 66 children (24 with EH, 42 with WCH, males 61%, median age of 13 years, range 10-17 years) were enrolled in the study. The demographic, anthropometric, laboratory tests, vascular ultrasound, and conventional echocardiographic parameters were similar between the 2 groups. There was a very small difference in MPI between the EH and WCH children (0.28 SD: 0.07 vs. 0.31 SD: 0.08, P = 0.045). However, in EH children, MPI increased by 0.14 units for every 10 unit increase in mean ABPM systolic BP (95% confidence interval: 0.03-0.25). CONCLUSIONS We found the increasing MPI was associated with increasing 24-hour mean systolic BP in children with EH. Therefore, MPI may have utility as a single, quick, noninvasive method of detection and tracking of subclinical hypertensive heart disease.
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Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA; Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA;
| | - Rabih K Hamzeh
- Division of Pediatric Cardiology, Texas Tech University, El Paso, Texas, USA
| | - Tim Poffenbarger
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA
| | - Karen McNiece-Redwine
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Arkansas, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Syed Shahrukh Hashmi
- Pediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, Texas, USA
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Urbina EM, Khoury PR, McCoy CE, Daniels SR, Dolan LM, Kimball TR. Comparison of mercury sphygmomanometry blood pressure readings with oscillometric and central blood pressure in predicting target organ damage in youth. Blood Press Monit 2016; 20:150-6. [PMID: 25647284 DOI: 10.1097/mbp.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Hypertension (HT) is an important risk factor for target organ damage (TOD). New methods for measuring BP are replacing mercury sphygmomanometry in many clinics. We examined the utility of different BP measurement techniques in predicting subclinical TOD in adolescents and young adults. METHODS Participants in a study of the cardiovascular effects of obesity and type 2 diabetes were evaluated (N=677, 18±3.3 years, 35% male, 60% non-White, 30% with type 2 diabetes). We measured adiposity, laboratory data, left ventricular mass, carotid intima-media thickness, and pulse wave velocity. BP was measured three times by mercury sphygmomanometry (BPm), using an oscillometric device (BPo), and by arterial tonometry to measure central aortic BP (BPc). Participants were stratified as normotensive, prehypertensive, or hypertensive. RESULTS The prevalence of HT in this cohort with a mean BMI of 31 was the highest on BPo measurement (16%), followed by BPm (11%) and BPc (9%; P≤0.001) measurements. BPm was the most consistent in differentiating left ventricular mass and pulse wave velocity among participants in the prehypertensive group as compared with the normotensive and hypertensive groups. Mercury BP measurement was also more sensitive and specific at predicting greater left ventricular mass, pulse wave velocity, and carotid thickness compared with other BP measurement techniques in logistic regression. CONCLUSION We conclude that mercury sphygmomanometry should remain the gold standard for evaluation of HT and the risk for TOD in adolescents and young adults.
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Affiliation(s)
- Elaine M Urbina
- aCincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio bDepartment of Pediatrics, University of Colorado, Aurora, Colorado, USA
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Abstract
Hypertension has become a serious global public health burden because of its high incidence and concomitant risk of cardiovascular disease. Many studies have verified that risk factors, such as hypertension and obesity which are responsible for cardiovascular disease, start in early childhood. In Asian countries, the prevalence of hypertension in the pediatric age group has become more prevalent than ever before with the increasing obesity epidemic. To tackle the epidemic of cardiovascular disease, a leading cause of death and disability of non-communicable diseases in Asian countries, population-based measures aiming at reducing harmful environmental factors to blood pressure and body weight must be applied to individuals in their early childhood, as early as the fetal stage. This review focused on the prevalence of pediatric hypertension in Asian countries and outlined several considerations for accurate blood pressure (BP) measurement and evaluation, along with an overview of pathophysiology of fetal programming and obesity related with childhood hypertension.
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Childhood Obesity, Arterial Stiffness, and Prevalence and Treatment of Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:339. [DOI: 10.1007/s11936-014-0339-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.
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Abstract
Over the last two decades, essential hypertension has become common in adolescents, yet remains under-diagnosed in absence of symptoms. Diagnosis is based on normative percentiles that factor in age, sex and height. Evaluation is more similar to adult essential hypertension than childhood secondary hypertension. Modifiable risk factors such as obesity, sodium consumption and low exercise should be addressed first. Many anti-hypertensive medications now have specific regulatory approval for children. Sports participation need not be limited in mild or well-controlled cases. Primary care physicians play an important role in reduction of cardiovascular mortality by early detection and referral when needed.
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Karpettas N, Nasothimiou E, Kollias A, Vazeou A, Stergiou GS. Ambulatory and home blood pressure monitoring in children and adolescents: diagnosis of hypertension and assessment of target-organ damage. Hypertens Res 2013; 36:285-92. [PMID: 23344131 DOI: 10.1038/hr.2012.220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prevalence of elevated blood pressure in children and adolescents is more common than previously believed and often represents the early onset of essential hypertension, particularly in adolescents. The definition of hypertension in children is based on distribution criteria and normalcy tables that provide blood pressure percentiles for each measurement method (office, ambulatory and home) according to the individual's age, gender and body size. Owing to the white coat and masked hypertension phenomena, ambulatory blood pressure monitoring is indispensable for the diagnosis of hypertension in children. Home blood pressure monitoring in children has been less well studied, and at present, treatment decisions should not be based solely on such measurements. Hypertension-induced preclinical target-organ damage (mainly echocardiographic left ventricular hypertrophy) is not uncommon in children and should be evaluated in all hypertensive children. Other indices of target-organ damage, such as carotid intima-media thickness, pulse wave velocity and microalbuminuria, remain under investigation in pediatric hypertension.
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Affiliation(s)
- Nikos Karpettas
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece
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