Hypertension and childhood stroke

Association between the Systolic Blood Pressure Trajectory and Risk of Stroke in a Health-Management Population in Jiaozuo, China

The trajectories of systolic blood pressure (SBP) in a screening population in Jiaozuo were examined, and the association between the different types of SBP trajectories and the risk of stroke was evaluated. Data of a fixed cohort population from the Jiaozuo Stroke Prevention and Control Project Management Special Database System that underwent community screening in 2015, 2017, 2019, and 2021 were collected. Ultimately, a total of 1,451 participants who met the inclusion criteria for this study were included in the analysis, which was performed using group trajectory modeling. The baseline SBP for each trajectory subgroup was characterized at follow-up. Kaplan-Meier analysis for each trajectory group was also performed, and the relationship between the SBP trajectory and risk of stroke onset during follow-up was validated using a Cox proportional hazards model. Based on the SBP from 2015 to 2021, this cohort population was divided into three groups based on the trajectory development patterns: the low-stable group (37.6%), the moderate-increasing group (53.4%), and the high-acutely increasing group (9%). Gender, age, body mass index, diastolic blood pressure, and fasting blood glucose level were predictive factors for the SBP trajectory group. The cumulative survival risk in the high-acutely increasing group was higher than that of the other two groups. After adjusting for potential confounding factors and using the low-stable group as a reference, the hazard ratios (95% confidence interval) for the risk of stroke onset in the moderate-increasing and high-acutely increasing groups were 1.38 (0.91-2.07) and 1.51 (0.82-2.76), respectively. The results of the analysis demonstrate that higher blood pressure trajectories are associated with a higher risk of stroke and that the risk of stroke can be reduced by better control and management of the SBP.

Acute Hospital Management of Pediatric Stroke

The field of pediatric stroke has historically been hampered by limited evidence and small patient cohorts. However the landscape of childhood stroke is rapidly changing due in part to increasing awareness of the importance of pediatric stroke and the emergence of dedicated pediatric stroke centers, care pathways, and alert systems. Acute pediatric stroke management hinges on timely diagnosis confirmed by neuroimaging, appropriate consideration of recanalization therapies, implementation of neuroprotective measures, and attention to secondary prevention. Because pediatric stroke is highly heterogenous in etiology, management strategies must be individualized. Determining a child's underlying stroke etiology is essential to appropriately tailoring hyperacute stroke management and determining best approach to secondary prevention. Herein, we review the methods of recognition, diagnosis, management, current knowledge gaps and promising research for pediatric stroke.

Blood pressure in children with sickle cell disease is higher than in the general pediatric population

Background

Sickle cell disease (SCD) is associated with an increased risk of cardiovascular disease that may be due to a variety of possible risk factors, including abnormal blood pressure. Blood pressure (BP) of children and adolescents with SCD has been reported to be lower compared to the BP of the general pediatric population.

Methods

To confirm this prior observation, we compared reference BP values for children with SCD with reference BP values of the general pediatric population. We hypothesized that children with SCD do not have lower BPs than children without SCD.

Results

Systolic BP differed for both males and females, over the different age groups between pediatric subjects with and without SCD. Systolic BP was higher in children with SCD, in both obese and non-obese populations. Diastolic BP did not differ between the groups.

Conclusions

Our analysis demonstrated that systolic BP values are indeed higher in children with SCD than in the general pediatric population. This finding is consistent with the most recent literature showing abnormal BP patterns in the SCD pediatric population utilizing 24-hour BP monitoring devices. This is an important step for recognizing abnormal BP as a risk factor for cardio- and neurovascular events in SCD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03584-9.

A child diagnosed with midaortic syndrome and inherited thrombophilia after presenting with a stroke: A case report

A 5-year-old female patient presented to the emergency room with right upper limb weakness, inability to speak and left side deviation of the mouth. Computed tomography (CT) scan was done and she was diagnosed with ischemic stroke. During her medical evaluation she was found to have high blood pressure (186/104 mm Hg). Investigations done to evaluate for secondary causes of hypertension and stroke revealed that she has inherited thrombophilia and abdominal aortic coarctation. Balloon angioplasty was done that lowered her elevated blood pressure, which was not responding well to antihypertensive medications, to near normal value for her age.

•

MAS is a very rare condition, characterized by narrowing of distal thoracic aorta or abdominal aorta.

•

Pediatric Patients can have a stroke due to a rare underlying condition.

•

The patient reported had a contellation of two conditions, inherited thromophilia and MAS.