Arterial hypertension in children

Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair

Pulmonary hypertension (PH) and cardiac dysfunction are established comorbidities of congenital diaphragmatic hernia (CDH). However, there is very little data focusing on arterial hypertension in CDH. This study aims to investigate the incidence of arterial hypertension in neonates with CDH at hospital discharge. Archived clinical data of 167 CDH infants who received surgical repair of the diaphragmatic defect and survived for > 60 days were retrospectively analyzed. Blood pressure (BP) values were averaged for the last 7 days before discharge and compared to standard BP values for sex, age, and height provided by the AHA in 2004. BP values reaching or extending the 95th percentile were defined as arterial hypertension. The use of antihypertensive medication was analyzed at discharge and during hospitalization. Arterial hypertension at discharge was observed in 19 of 167 infants (11.3%) of which 12 (63%) were not receiving antihypertensive medication. Eighty patients (47.9%) received antihypertensive medication at any point during hospitalization and 28.9% of 152 survivors (n = 44) received antihypertensive medication at discharge, although in 45.5% (n = 20) of patients receiving antihypertensive medication, the indication for antihypertensive medication was myocardial hypertrophy or frequency control. BP was significantly higher in ECMO compared to non-ECMO patients, despite a similar incidence of arterial hypertension in both groups (13.8% vs. 10.1%, p = 0.473). Non-isolated CDH, formula feeding, and minimal creatinine in the first week of life were significantly associated with arterial hypertension on univariate analysis. Following multivariate analysis, only minimal creatinine remained independently associated with arterial hypertension.   Conclusion: This study demonstrates a moderately high incidence of arterial hypertension in CDH infants at discharge and an independent association of creatinine values with arterial hypertension. Physicians should be aware of this risk and include regular BP measurements and test of renal function in CDH care and follow-up. What is Known: • Due to decreasing mortality, morbidity is increasing in surviving CDH patients. • Pulmonary hypertension and cardiac dysfunction are well-known cardiovascular comorbidities of CDH. What is New: • There is a moderately high incidence of arterial hypertension in CDH infants at discharge even in a population with frequent treatment with antihypertensive medication. • A more complicated hospital course (ECMO, higher degree of PH, larger defect size) was associated with a higher risk for arterial hypertension.

STATE OF AUTONOMIC REGULATION AND CEREBROVASCULAR REACTIVITY IN PATIENTS WITH HEADACHE WITH ARTERIAL HYPERTENSION

OBJECTIVE

The aim: A comprehensive assessment of the state of the autonomic nervous system and cerebrovascular reactivity of the cerebral blood flow in the patients with the headache accompanied by arterial hypertension (AH) and somatoform autonomic dysfunction (SAD).

PATIENTS AND METHODS

Materials and methods: We conducted the clinical, autonomic regulation and Doppler sonography examination of 124 young patients (18-45 years old), including 51 men and 73 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2018-2021. All patients with cephalgias were divided into three groups: with AH stage II (Group I - 41 patients), AH stage I (Group II - 40 patients), SAD (Group III - 43 patients). The control group consisted of 50 patients of the corresponding gender and age.

RESULTS

Results: The intensity of cephalalgia in patients with SAD was maximum. The autonomic tone (AT) was changed in 68.5%examined patients. It had a pronounced shift towards sympathicotonia. According to the visual analogue scale the maximum intensity of cephalgias was against the sympathicotonia. In the groups with organic lesions of the cerebral vessels the latent period delay was registered with the progression of the organic pathology. The regularity was revealed - the shortening of the evoked skin sympathetic potentials latency with the severity of cephalalgia, which can be interpreted as an increase in ergotropic effects with the realisation of the pain syndrome. The obtained data on the state of the AT indicate the depletion of the ergotropic processes with the progression of cerebral ischemia with a known increase in parasympathicotonia. In the patients of SAD group the CrCO2 and KrFNTvalues were significantly increased, in AH stage I group they slightly exceeded the standard values , in AH stage II group they were reduced. The reactivity to the orthostatic loads and functional metabolic test in all groups exceeded the control values.

CONCLUSION

Conclusions: 1. The cephalgic syndrome is one of the main symptoms of the autonomic dysfunction and arterial hypertension; the frequency and intensity of the headache increases with the hyperreactivity of the sympathetic system. 2. The SSP data indicate that the sympathetic activity triggers and maintains the pain syndrome, and can also be realized in the form of arterial hypertension. 3. The dysfunction of the central link of the GSR indicates the instability of the autonomous regulation, the work of the limbic-reticular complex, which is clinically manifested by the changes in the cerebral vascular tone. 4. The cerebrovascular hyperreactivity as a sign of the search for the optimal sanogenetic variant of the cerebral hemodynamics in patients with SAD and AH stage I occurs predominantly due to the vasodilatory component. 5. In the patients with AH stage II the vasoconstrictor reactions are observed with the depletion of the vasodilation reserves, which is a marker of the autoregulation failure.

Cardiometabolic risk factors and early indicators of vascular dysfunction: a cross-sectional cohort study in South African adolescents

OBJECTIVES

Prevalence of child and adolescents' overweight and obesity in low- and middle-income countries has increased dramatically. Simultaneously, the incidence of pre-hypertension/hypertension is also increasing in children, which, in turn, predisposes these children to the risk of cardiovascular disease (CVD) in later life. The present study assessed cardiometabolic risk factors and early indicators of vascular dysfunction in adolescents from a low socio-economic rural area in South Africa.

DESIGN

Cross-sectional cohort study.

SETTING

The study was conducted in public schools in Mthatha, OR Tambo district municipality, Eastern Cape Province, South Africa.

PARTICIPANTS

A total of 244 adolescents (188 females) of African ancestry aged 13-16 years were enrolled.

PRIMARY AND SECONDARY OUTCOME MEASURES

Anthropometric and haemodynamic measures and pulse wave velocity (PWV) were related to overweight/obesity and hypertension. Blood markers of cardiometabolic syndrome were assessed as well as vascular function (via PWV).

RESULTS

One-third (33.0%) of the adolescents exceeded the age and sex-specific body mass index percentiles for overweight (≥85th) or obesity (>95th) with a prevalence of 61.1% pre-hypertensives in this group. Overweight/obesity and hypertension were associated with higher triglycerides (lean:overweight: 0.79<1.01 mmol/L; normotensive:hypertensive: 0.82<0.89 mmol/L). Fasting glucose was higher in hypertensive as compared to normotensive adolescents (4.85>4.69 mmol/L, p<0.05). PWV was elevated in 25.9% of the children and significantly correlated with asymmetric dimethylarginine and systolic blood pressure (p<0.001).

CONCLUSION

Overweight/obesity and hypertension show a high prevalence in rural South African youth. Almost half of the studied adolescents are at risk for developing CVD. The high association between cardiometabolic risk factors and PWV further suggests that hypertension in adolescents may promote the progression of CVD in adulthood. Early detection of those at risk and the implementation of preventive strategies in underprivileged young people is urgently needed to stop the progression of vascular damage and manifestation of CVD in rural African children.

Associations of the hypertension-related single nucleotide polymorphism rs11191548 with high-density lipoprotein cholesterol and leptin in Chinese children

Background

The genome-wide association study has founded hypertension-related single nucleotide polymorphism (SNP) rs11191548 near CYP17A1 encoding a key enzyme involved in steroid metabolism, but the molecular mechanisms are not understood and the associations of the SNP with hypertension-related traits are not fully described, especially in children. The aim of the present study is to investigate the associations between the SNP and two hypertension-related traits, lipids and leptin.

Methods

We genotyped the SNP in Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study. A total of 3503 children participated in the study.

Results

The SNP rs11191548 was significantly associated with high-density lipoprotein cholesterol (HDL) (P = 0.014 and 0.028, respectively) and leptin (P = 0.011 and 0.026, respectively) under an additive model after adjustment for age, gender, and systolic blood pressure (SBP) or diastolic blood pressure (DBP). There was a statistically significant association of rs11191548 with high leptin after adjustment for age, gender, and SBP or DBP. The P-values remain significant after correction for multiple testing.

Conclusions

We demonstrate for the first time that the SNP rs11191548 near CYP17A1 is associated with HDL and leptin in Chinese children. These novel findings provide important evidence that HDL and leptin maybe possibly mediate the process of CYP17A1 involved in hypertension.

Electronic supplementary material

The online version of this article (10.1186/s12881-018-0523-y) contains supplementary material, which is available to authorized users.

Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis

BACKGROUND

Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa.

METHODS

We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I²) was assessed via the χ² test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029.

FINDINGS

We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2-19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2-24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2-6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1-30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1-42·6) versus normal-weight children (5·5%, 3·1-8·4; p<0·0001).

INTERPRETATION

This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa.

FUNDING

None.