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Doğan K, Başar EZ, Aytaç MB, Şahin N, Bayrak YE, Bek K, Güngör HS, Sönmez HE, Babaoğlu K. Evaluation of endothelial dysfunction in hypertensive children and adolescents. Pediatr Nephrol 2024; 39:1193-1199. [PMID: 37914964 DOI: 10.1007/s00467-023-06205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Atherosclerotic changes can be attributed to early endothelial damage in individuals with hypertension. We aimed to explore the relationship between endothelial dysfunction and hypertension in newly diagnosed children without end-organ damage, considering carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and functional capillaroscopy parameters. We also analyzed the differences between dipper and non-dipper patients. METHODS In this cross-sectional study, 20 patients diagnosed with essential hypertension with no target organ damage, and 20 age and sex-matched healthy volunteers were enrolled. The patient group comprised newly diagnosed individuals not receiving antihypertensive treatment. Hypertensive patients were divided into two groups (dipper and non-dipper patients). The measurements of CIMT, brachial FMD, and functional capillaroscopy were performed before starting treatment. RESULTS Among the patients, 11 were boys, and 9 were girls, with a median age of 16.0 (2.13) years. Of 20 hypertensive patients, 10 were dipper and 10 were non-dipper. Significant differences were observed between the hypertensive patients and controls in terms of CIMT (p = 0.04), brachial artery FMD (p = 0.02), and functional capillary density (p < 0.001). Hypertensive patients exhibited increased CIMT, reduced brachial artery FMD, and lower capillary density. However, there were no differences between dippers and non-dippers regarding age, sex, height SDS, weight SDS, CIMT SDS, brachial artery FMD, and capillary density. CONCLUSIONS Understanding the vascular consequences associated with essential hypertension emphasizes the importance of early detection and management of hypertension. Herein, we have effectively highlighted significant endothelial changes through the analysis of three parameters in newly diagnosed children without apparent target organ damage.
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Affiliation(s)
- Kenan Doğan
- Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Eviç Zeynep Başar
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mehmet Baha Aytaç
- Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yunus Emre Bayrak
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kenan Bek
- Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Hüseyin Salih Güngör
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Karam S, Cohen DL, Jaoude PA, Dionne J, Ding FL, Garg A, Tannor EK, Chanchlani R. Approach to Diagnosis and Management of Hypertension: A Comprehensive and Combined Pediatric and Adult Perspective. Semin Nephrol 2023; 43:151438. [PMID: 37951795 DOI: 10.1016/j.semnephrol.2023.151438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The global prevalence of primary hypertension has been increasing both in children and in the adolescent and adult populations and can be attributed to changes in lifestyle factors with an obesity epidemic, increased salt consumption, and sedentary lifestyles. Childhood blood pressure is the strongest predictor of adult hypertension. Although hypertension in adults is associated strongly with an increased risk for cardiovascular disease, chronic kidney disease, and mortality, outcomes in children are defined less clearly. In adults, major guidelines agree on a threshold of less than 120/80 mm Hg as the optimal blood pressure (BP) and recommend a target of less than 130/80 mm Hg for treatment in most cases. In children, international pediatric guidelines recommend using thresholds based on the normative distribution of BP in healthy normal-weight children. Out-of-office BP assessment is extremely useful for confirming the diagnosis of hypertension and monitoring response to treatment. Lifestyle modifications are instrumental whether coupled or not with pharmacologic management. New agents such as nonsteroidal mineralocorticoid-receptor antagonists, aminopeptidase A inhibitors, aldosterone synthase inhibitors, and dual endothelin antagonists hold significant promise for resistant hypertension. The transition from pediatric to adult care can be challenging and requires careful planning and effective coordination within a multidisciplinary team that includes patients and their families, and pediatric and adult providers.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN.
| | - Debbie L Cohen
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pauline Abou Jaoude
- Division of Pediatric Nephrology, Hotel-Dieu de France-University Medical Center, Beirut, Lebanon
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - FangChao Linda Ding
- Division of Nephrology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Anika Garg
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana; Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Kovačević A, Vidatić I, Škorić I, Valent Morić B. Does the Body Mass Index Category Influence Ambulatory Blood Pressure Parameters in Office Normotensive Obese Children? Pediatr Cardiol 2023; 44:599-606. [PMID: 35809123 DOI: 10.1007/s00246-022-02963-4] [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] [Received: 04/09/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
The aim of our study was to investigate the influence of the degree of obesity on ambulatory blood pressure parameters in selected group of office normotensive obese children and adolescents. Our study involved 119 obese patients (55 males, 46.2%) aged 7-18 years divided into 3 groups based on their body mass index Z-score, who underwent ambulatory blood pressure monitoring. Our results show that obese patients, even when office normotensive, have alterations in blood pressure values obtained by ambulatory blood pressure monitoring. We found a positive correlation between systolic and diastolic blood pressure and body mass index in our patients (p [Formula: see text] 0.001). Daytime blood pressure load correlated with rising body mass index and was higher in groups II and III compared to group I (p < 0.001). Body mass index category did not influence the dipping pattern in our subjects although most of our subjects (66.4%) showed non-dipping pattern for systolic blood pressure. The difference in blood pressure variability was confirmed only for daytime systolic and diastolic values between groups I and II (p = 0.019 and p = 0.002, respectively). In conclusion, our study showed that in office normotensive obese children and adolescents, systolic and diastolic blood pressure values obtained by ambulatory blood pressure monitoring are higher in subjects with higher body mass index. Patients with increased body mass index also have higher percentage of blood pressure readings above 95th percentile and increased daytime blood pressure variability. Obese patients show non-dipping pattern, independently of the rising body mass index category.
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Affiliation(s)
- Ana Kovačević
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia.
| | - Ines Vidatić
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Iva Škorić
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Bernardica Valent Morić
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
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Sinha MD, Azukaitis K, Sladowska-Kozłowska J, Bårdsen T, Merkevicius K, Karlsen Sletten IS, Obrycki Ł, Pac M, Fernández-Aranda F, Bjelakovic B, Jankauskiene A, Litwin M. Prevalence of left ventricular hypertrophy in children and young people with primary hypertension: Meta-analysis and meta-regression. Front Cardiovasc Med 2022; 9:993513. [PMID: 36386367 PMCID: PMC9659762 DOI: 10.3389/fcvm.2022.993513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is the main marker of HMOD in children and young people (CYP). We aimed to assess the prevalence of LVH and its determinants in CYP with primary hypertension (PH). METHODS A meta-analysis of prevalence was performed. A literature search of articles reporting LVH in CYP with PH was conducted in Medline, Embase, and Cochrane databases. Studies with a primary focus on CYP (up to 21 years) with PH were included. Meta-regression was used to analyze factors explaining observed heterogeneity. RESULTS The search yielded a total of 2,200 articles, 153 of those underwent full-text review, and 47 reports were included. The reports evaluated 51 study cohorts including 5,622 individuals, 73% male subjects, and a mean age of 13.6 years. LVH was defined as left ventricle mass index (LVMI) ≥ 95th percentile in 22 (47%), fixed cut-off ≥38.6 g/m2.7 in eight (17%), sex-specific fixed cut-off values in six (13%), and miscellaneously in others. The overall prevalence of LVH was 30.5% (95% CI 27.2-33.9), while heterogeneity was high (I 2 = 84%). Subgroup analysis including 1,393 individuals (76% male subjects, mean age 14.7 years) from pediatric hypertension specialty clinics and LVH defined as LVMI ≥95th percentile only (19 study cohorts from 18 studies), reported prevalence of LVH at 29.9% (95% CI 23.9 to 36.3), and high heterogeneity (I 2 = 84%). Two studies involving patients identified through community screening (n = 1,234) reported lower LVH prevalence (21.5%). In the meta-regression, only body mass index (BMI) z-score was significantly associated with LVH prevalence (estimate 0.23, 95% CI 0.08-0.39, p = 0.004) and accounted for 41% of observed heterogeneity, but not age, male percentage, BMI, or waist circumference z-score. The predominant LVH phenotype was eccentric LVH in patients from specialty clinics (prevalence of 22% in seven studies with 779 participants) and one community screening study reported the predominance of concentric LVH (12%). CONCLUSION Left ventricular hypertrophy is evident in at least one-fifth of children and young adults with PH and in nearly a third of those referred to specialty clinics with a predominant eccentric LVH pattern in the latter. Increased BMI is the most significant risk association for LVH in hypertensive youth.
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Affiliation(s)
- Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
- Kings College London, London, United Kingdom
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Tonje Bårdsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kajus Merkevicius
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Łukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Michał Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Fernando Fernández-Aranda
- University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Bojko Bjelakovic
- Clinic of Pediatrics, Clinical Center, Nis, Serbia
- Medical Faculty, University of Nis, Nis, Serbia
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
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Optimal cutoff of the abdominal skinfold thickness (AST) to predict hypertension among Chinese children and adolescents. J Hum Hypertens 2022; 36:860-865. [PMID: 34244593 DOI: 10.1038/s41371-021-00573-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/08/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
Previous studies have shown that the correlation between the abdominal skinfold thickness (AST) and hypertension is better than that observed using the body mass index (BMI) or waist-to-height ratio (WHtR). We aimed to explore the optimal cutoff of the AST to predict childhood hypertension. The AST percentiles were calculated based on 215,223 students from the Chinese National Survey on Students' Constitution and Health (CNSSCH) in 2010 using the LMS method. Logistic regression model and Receiver operating characteristic (ROC) curves were used to evaluate the optimal cutoff of the AST to predict hypertension based on a sample of 683 children aged 8-15 years. The prevalence of hypertension was 5.71% (5.45% in boys and 6.01% in girls). The area under the ROC curve [AUC (95% CI)] values of the BMI, WHtR and AST to predict hypertension were 0.62 (0.47-0.77), 0.61 (0.45-0.76), and 0.67 (0.54-0.80) in boys and 0.59 (0.46-0.71), 0.65 (0.50-0.80), and 0.70 (0.57-0.83) in girls, respectively. The AUC value at P85 of AST in boys and that at P90 of AST in girls to predict hypertension were higher than other percentile values of AST. The OR (95% CI) values of the optimal cutoff of the AST associated with hypertension were 2.90 (1.17-7.20) and 4.91 (1.81-13.31) in boys and girls, respectively, and were higher than those associated with overweight/obesity (based on BMI) and abdominal obesity (based on WHtR).The AST was more effectively associated with hypertension than the BMI and WHtR, and the optimal cutoff to predict hypertension was at P85 for boys and P90 for girls.
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6
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Soyaltin E, Demir BK, Erfidan G, Çamlar SA, Alaygut D, Mutlubaş F. Effects of ambulatory blood pressure monitoring parameters on left ventricular mass index in hypertensive children. Blood Press Monit 2022; 27:213-219. [PMID: 35258018 DOI: 10.1097/mbp.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to evaluate the effects of blood pressure (BP) values obtained by 24-h ambulatory BP monitoring (ABPM) of hypertensive children and adolescents on left ventricular mass index (LVMI). METHODS Patients diagnosed with HT with BP measurements confirmed with ABPM and evaluated with echocardiography for LVMI were included. The patients were divided into two groups according to their BMI as obese and nonobese. SDSs of ABPM parameters were compared between the groups. RESULTS A total of 158 children with HT were included in the study. Ninety of these patients were obese. In obese and nonobese cases, mean SDS levels were similar in ABPM parameters, whereas LVMI was significantly higher in obese patients ( P = 0.049). There was a significant correlation between LVMI and 24-h SBP SDS, daytime SBP SDS, 24-h SBP load and daytime BP load. In obese cases, there was a statistically significant correlation between LVMI and 24-h SBP SDS, daytime SBP SDS, 24-h SBP load, daytime SBP load as well as nighttime SBP SDS and nighttime SBP load. When the whole group was evaluated, 24-h SBP SDS was the most effective parameter influencing LVMI ( P = 0.001). Similarly, the most effective ABPM parameter on LVMI in obese patients was 24-h SBP SDS ( P = 0.001). CONCLUSION A significantly higher rate of LVMI in obese patients suggests that obesity itself is an effective factor on LVMI. In addition, systolic hypertension is more effective on cardiac functions compared with DBP measurements and systolic-DBP dipping ratios.
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Affiliation(s)
- Eren Soyaltin
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Belde Kasap Demir
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
- Division of Pediatric Nephrology and Rheumatology, Department of Pediatrics, Izmir Katip Çelebi University Medical Faculty, İzmir, Turkey
| | - Gökçen Erfidan
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Seçil Arslansoyu Çamlar
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Demet Alaygut
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
| | - Fatma Mutlubaş
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital
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7
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Sharma AP, Altamirano-Diaz L, Mohamed Ali M, Stronks K, Kirpalani A, Filler G, Norozi K. Diagnosis of hypertension: Ambulatory pediatric American Heart Association/European Society of Hypertension versus blood pressure load thresholds. J Clin Hypertens (Greenwich) 2021; 23:1947-1956. [PMID: 34668643 PMCID: PMC8630605 DOI: 10.1111/jch.14368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/27/2022]
Abstract
The agreement between the traditionally‐used ambulatory blood pressure (ABP)‐load thresholds in children and recently‐recommended pediatric American Heart Association (AHA)/European Society of Hypertension (ESH) ABP thresholds for diagnosing ambulatory hypertension (AH), white coat hypertension (WCH), and masked hypertension (MH) has not been evaluated. In this cross‐sectional study on 450 outpatient participants, the authors evaluated the agreement between previously used ABP‐load 25%, 30%, 40%, 50% thresholds and the AHA/ESH thresholds for diagnosing AH, WCH, and MH. The American Academy of Pediatrics thresholds were used to diagnose office hypertension. The AHA threshold diagnosed ambulatory normotension/hypertension closest to ABP load 50% in 88% (95% CI 0.79, 0.96) participants (k 0.67, 95% CI 0.59, 0.75) and the ESH threshold diagnosed ambulatory normotension/hypertension closest to ABP load 40% in 86% (95% CI 0.77, 0.94) participants (k 0.66, 95% CI 0.59, 0.74). In contrast, the AHA/ESH thresholds had a relatively weaker agreement with ABP load 25%/30%. Therefore, the diagnosis of AH was closest between the AHA threshold and ABP load 50% (difference 3%, 95% CI ‐2.6%, 8.6%, p = .29) and between the ESH threshold and ABP load 40% (difference 4%, 95% CI ‐2.1%, 10.1%, p = .19) than between the AHA/ESH and ABP load 25%/30% thresholds. A similar agreement pattern persisted between the AHA/ESH and various ABP load thresholds for diagnosing WCH and MH. The AHA and ESH thresholds diagnosed AH, WCH, and MH closest to ABP load 40%/50% than ABP load 25%/30%. Future outcome‐based studies are needed to guide the optimal use of these ABP thresholds in clinical practice.
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Affiliation(s)
- Ajay P Sharma
- University of Western Ontario, London, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada.,Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Luis Altamirano-Diaz
- University of Western Ontario, London, Ontario, Canada.,Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada.,Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | | | | | - Amrit Kirpalani
- University of Western Ontario, London, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada.,Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Guido Filler
- University of Western Ontario, London, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada.,Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Kambiz Norozi
- University of Western Ontario, London, Ontario, Canada.,Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada.,Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada.,Department of Pediatric Cardiology and Intensive care, Medical school Hannover, Hanover, Germany
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Mitsnefes M, Flynn JT, Brady T, Baker-Smith C, Daniels SR, Hayman LL, Tran A, Zachariah JP, Urbina EM. Pediatric Ambulatory Blood Pressure Classification: The Case for a Change. Hypertension 2021; 78:1206-1210. [PMID: 34601972 PMCID: PMC8516706 DOI: 10.1161/hypertensionaha.121.18138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In 1997, Soergel et al1 published the first set of normative values for ambulatory blood pressure monitoring (ABPM) in children. Since then, the clinical utility of ABPM has increased dramatically, and now, ABPM is accepted as the standard method to confirm the diagnosis of hypertension in children. Despite significant progress in the field of pediatric ABPM, many important questions remain unanswered. One of the most controversial issues is how to define ambulatory hypertension in children. The purpose of this review is to discuss the limitations of the current pediatric ABPM classification scheme and to provide the justification and rationale for a new classification.
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Affiliation(s)
- Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (M.M., E.M.U.)
| | - Joseph T Flynn
- University of Washington and Seattle Children's Hospital (J.T.F.)
| | - Tammy Brady
- Johns Hopkins University, Baltimore, MD (T.B.)
| | | | | | | | - Andrew Tran
- Nationwide Children's Hospital, The Ohio State University, Columbus (A.T.)
| | | | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (M.M., E.M.U.)
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Abstract
Pediatric hypertension is becoming of increasing concern as the incidence rate increases alongside pediatric obesity. Practitioners need to be aware of the screening recommendations for early recognition and management of this disorder. Lifestyle modifications should be addressed early and specialty referral considered if the child is not improving. Further work-up to rule out secondary causes of pediatric hypertension should also be considered in any child with stage 2 hypertension and in those with persistently elevated blood pressures. Early recognition and management are key to not only preventing present complications but also future cardiovascular disease in adulthood.
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Affiliation(s)
- Christopher Fox
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA; Department of Community and Family Medicine, Truman Medical Centers, Kansas City, MO, USA.
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10
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Hamdani G, Mitsnefes MM, Flynn JT, Becker RC, Daniels S, Falkner BE, Ferguson M, Hooper SR, Hanevold CD, Ingelfinger JR, Lande M, Martin LJ, Meyers KE, Rosner B, Samuels J, Urbina EM. Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents. Hypertension 2021; 78:30-37. [PMID: 33966453 DOI: 10.1161/hypertensionaha.120.16896] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Gilad Hamdani
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
| | - Mark M Mitsnefes
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
| | - Joseph T Flynn
- Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | | | | | | | | | | | | | | | - Marc Lande
- University of Rochester Medical Center, Rochester, NY (M.L.)
| | - Lisa J Martin
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
| | | | | | - Joshua Samuels
- University of Texas Health Sciences Center, Houston (J.S.)
| | - Elaine M Urbina
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
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11
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Gregory L, Doucette J, Duffy L, Manion A. Improving Access to Care for Pediatric Patients With Hypertension. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Gender-Specific Longitudinal Association of Sleep Duration with Blood Pressure among Children: Evidence from CHNS 2004-2015. Int J Hypertens 2020; 2020:5475297. [PMID: 32765906 PMCID: PMC7374217 DOI: 10.1155/2020/5475297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose We conducted this study to add the evidence regarding the gender-specific association between sleep duration and blood pressure (BP) in children. Methods A secondary analysis was performed among 1000 children aged 7–13 years, who had at least two rounds of survey records in China Health and Nutrition Survey through 2004–2015. Generalized estimating equation was used to explore the gender-specific association of sleep duration with BP. The subgroup analysis was applied in those participants with normal weight. Results The time trend of decreasing sleep duration, along with increasing BP level, was observed in each age group during the survey period. Short sleepers (<9 hours per day) have higher level of both systolic BP (SBP) and diastolic BP (DBP) than long sleepers in girls (all p < 0.05). By contrast, only SBP was higher in short sleepers among boys (p < 0.05). There was gender difference in the association between sleep duration and DBP (p for interaction <0.05). The stratification analysis showed that short sleep duration could consistently predict a higher level of diastolic BP (DBP) in both crude (β = 2.968, 95% CI: 1.629, 4.306) and adjusted models (β = 1.844, 95% CI: 0.273, 3.416) only in girls. Sleep duration was also analyzed as continuous variable, and the very similar associations were observed. Moreover, the established associations can be verified among children with normal weight. Conclusions There was a time trend of decreasing sleep duration alongside increasing BP among children from 2004 to 2015. Short sleep duration was independently associated with increased DBP; however, only girls were susceptible to the association.
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Dereli Can G, Korkmaz MF, Can ME. Subclinical retinal microvascular alterations assessed by optical coherence tomography angiography in children with systemic hypertension. J AAPOS 2020; 24:147.e1-147.e6. [PMID: 32479999 DOI: 10.1016/j.jaapos.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the foveal avascular zone (FAZ) macular and peripapillary vessel density between children with high blood pressure and healthy subjects. METHODS A total of 40 eyes of 20 children with hypertension and 40 eyes of 20 age- and sex-matched healthy controls were included. Capillary vessel density (CVD) in superficial (SCP) and deep (DCP) retinal capillary plexus, peripapillary region, and FAZ were analyzed by optical coherence tomography angiography. RESULTS The mean ages were 15.2 ± 1.5 years (range, 10-18) in patients with hypertension and 14.4 ± 2.8 years (range, 10-18) in healthy controls (P = 0.742). The mean FAZ area measured 0.25 ± 0.10 mm2 in children with hypertension and 0.25 ± 0.09 mm2 in healthy controls (P = 0.765). There was no significant difference between study groups in any measure of the macular SCP (P > 0.05 for all); however, the mean whole image, inferior hemisphere, and para- and perifoveal measurements of the macular DCP were significantly lower in children with hypertension than in controls (P < 0.05 for all). CONCLUSIONS Although there was no evidence of hypertensive retinopathy, subthreshold microvascular alterations were found in the DCP of the retinal circulation in pediatric hypertensives. These alterations should be considered as prognostic cues when defining whole systemic response to high blood pressure in childhood.
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Affiliation(s)
- Gamze Dereli Can
- Department of Ophthalmology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Muhammet Furkan Korkmaz
- Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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14
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Lee J, McCulloch CE, Flynn JT, Samuels J, Warady BA, Furth SL, Seth D, Grimes BA, Mitsnefes MM, Ku E. Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD. Clin J Am Soc Nephrol 2020; 15:493-500. [PMID: 32160993 PMCID: PMC7133128 DOI: 10.2215/cjn.10130819] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Elevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters. RESULTS Overall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load. CONCLUSIONS BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3.
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Affiliation(s)
- Jason Lee
- Division of Pediatric Nephrology, University of California San Francisco, San Francisco, California; .,Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, Seattle Children's, Seattle, Washington
| | - Joshua Samuels
- Division of Pediatric Nephrology, Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas
| | - Bradley A Warady
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Susan L Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Divya Seth
- Division of Pediatric Nephrology, University of California San Francisco, San Francisco, California.,Department of Pediatrics, University of California San Francisco, San Francisco, California.,Division of Nephrology, University of California San Francisco, San Francisco, California.,Department of Internal Medicine, University of California San Francisco, San Francisco, California; and
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Mark M Mitsnefes
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elaine Ku
- Division of Pediatric Nephrology, University of California San Francisco, San Francisco, California.,Department of Pediatrics, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Division of Nephrology, University of California San Francisco, San Francisco, California.,Department of Internal Medicine, University of California San Francisco, San Francisco, California; and
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15
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Hanevold CD, Miyashita Y, Faino AV, Flynn JT. Changes in Ambulatory Blood Pressure Phenotype over Time in Children and Adolescents with Elevated Blood Pressures. J Pediatr 2020; 216:37-43.e2. [PMID: 31685228 DOI: 10.1016/j.jpeds.2019.09.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/04/2019] [Accepted: 09/25/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the stability of ambulatory blood pressure monitoring (ABPM) over time in children referred for evaluation of elevated BPs and assess for factors predicting change. STUDY DESIGN This retrospective chart review conducted at Seattle Children's Hospital and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh identified 124 children referred for elevated BPs with 2 ABPM studies at least 6 months apart. All subjects received lifestyle counseling. Subjects with secondary hypertension (HTN) or on antihypertensive medication were excluded. ABPM phenotype was classified using American Heart Association guidelines as showing normal BP, prehypertension, and HTN. Generalized linear mixed effect regression models were used to regress stable, improving, or worsening HTN outcomes at study follow-up on baseline BP index and load variables. RESULTS The median age of patients was 14.1 years (73% males) and the median interval between studies was 18 months. ABPM phenotype changed in 58 of 124 children, with 16% worsening and 31% improving. Older age was associated with persistence of HTN. Although not significant, decrease in body mass index z-score tracked with sustained normal ambulatory BPs. CONCLUSIONS Although the sample size is small, our study suggests ABPM phenotype shows variability over time. Further study is required to identify factors supporting risk for progression of ABPM phenotype over time.
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Affiliation(s)
- Coral D Hanevold
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
| | - Yosuke Miyashita
- University of Pittsburgh School of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Anna V Faino
- Seattle Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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16
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Affiliation(s)
- Pamela S Singer
- Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
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17
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Hamdani G, Flynn JT, Becker RC, Daniels SR, Falkner B, Hanevold CD, Ingelfinger JR, Lande MB, Martin LJ, Meyers KE, Mitsnefes M, Rosner B, Samuels JA, Urbina EM. Prediction of Ambulatory Hypertension Based on Clinic Blood Pressure Percentile in Adolescents. Hypertension 2019; 72:955-961. [PMID: 30354718 PMCID: PMC7202372 DOI: 10.1161/hypertensionaha.118.11530] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ambulatory blood pressure (BP) monitoring provides a more precise measure of BP status than clinic BP and is currently recommended in the evaluation of high BP in children and adolescents. However, ambulatory BP monitoring may not always be available. Our aim was to determine the clinic BP percentile most likely to predict ambulatory hypertension. We evaluated clinic and ambulatory BP in 247 adolescents (median age, 15.7 years; 63% white; 54% male). Clinic BP percentile (based on the fourth report and the 2017 American Academy of Pediatrics clinical practice guidelines) and ambulatory BP status (normal versus hypertension) were determined by age-, sex-, and height-specific cut points. Sensitivity and specificity of different clinic BP percentiles and cutoffs to predict ambulatory hypertension were calculated. Forty (16%) and 67 (27%) patients had systolic hypertension based on the fourth report and the 2017 guidelines, respectively, whereas 38 (15%) had wake ambulatory systolic hypertension. The prevalence of ambulatory wake systolic hypertension increased across clinic systolic BP percentiles, from 3% when clinic systolic BP was <50th percentile to 41% when ≥95th percentile. The 2017 guidelines' 85th systolic percentile had similar sensitivity (86.8%) and better specificity (57.4% versus 48.1%) than elevated BP (≥90th percentile or ≥120 mm Hg) to diagnose ambulatory hypertension. When evaluating adolescents for hypertension, 2017 guidelines' clinic systolic 85th percentile may be the optimal threshold at which to perform ambulatory BP monitoring.
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Affiliation(s)
- Gilad Hamdani
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | - Joseph T Flynn
- Seattle Children's Hospital, Washington (J.T.F., C.D.H.)
| | | | | | - Bonita Falkner
- Thomas Jefferson University Hospital, Philadelphia, PA (B.F.)
| | | | | | - Marc B Lande
- University of Rochester Medical Center, New York (M.B.L.)
| | - Lisa J Martin
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | - Bernard Rosner
- Harvard TH Chan School of Public Health, Boston, MA (B.R.)
| | | | - Elaine M Urbina
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
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18
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Ambulatory blood pressure monitoring tolerability and blood pressure status in adolescents: the SHIP AHOY study. Blood Press Monit 2019; 24:12-17. [PMID: 30451702 DOI: 10.1097/mbp.0000000000000354] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) provides a more precise assessment of blood pressure (BP) status than clinic BP and is currently recommended in the evaluation of elevated BP in children and adolescents. Yet, ABPM can be uncomfortable for patients and cumbersome to perform. OBJECTIVE Evaluation of the tolerability to ABPM in 232 adolescent participants (median age: 15.7 years, 64% white, 16% Hispanic, 53% male) in the Study of Hypertension In Pediatrics Adult Hypertension Onset in Youth and its potential effects on ABPM results. PARTICIPANTS AND METHODS Ambulatory BP status (normal vs. hypertension) was determined by sex and height-specific pediatric cut-points. Participants were asked to rank their wake and sleep tolerability to ABPM from 1 (most tolerant) to 10 (least tolerant); those with tolerability score of at least 8 were considered ABPM intolerant. RESULTS Forty-three (19%) participants had wake ambulatory hypertension (HTN), 42 (18%) had sleep ambulatory HTN, and 64 (28%) had overall (wake and/or sleep) ambulatory HTN. Forty (17%) participants were intolerant to ABPM during wake hours and 58 (25%) were intolerant during sleep. ABPM intolerance during wake (but not sleep) hours was independently associated with wake (odds ratio: 2.34, 95% confidence interval: 1.01-5.39) and overall (odds ratio: 2.94, 95% confidence interval: 1.21-7.18) ambulatory HTN. CONCLUSION Poor tolerability to ABPM is associated with a higher prevalence of ambulatory HTN in adolescents, and should be taken into consideration at time of ABPM interpretation.
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19
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Urbina EM, Lande MB, Hooper SR, Daniels SR. Target Organ Abnormalities in Pediatric Hypertension. J Pediatr 2018; 202:14-22. [PMID: 30122368 DOI: 10.1016/j.jpeds.2018.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati Children's, Cincinnati, OH
| | - Marc B Lande
- Department of Pediatrics, Pediatric Nephrology, University of Rochester School of Medicine, Rochester, NY
| | - Stephen R Hooper
- Department of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
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20
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Hypertension Diagnosis and Management in Children and Adolescents: Important Updates. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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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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22
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Ku E, McCulloch CE, Warady BA, Furth SL, Grimes BA, Mitsnefes MM. Twenty-Four-Hour Ambulatory Blood Pressure versus Clinic Blood Pressure Measurements and Risk of Adverse Outcomes in Children with CKD. Clin J Am Soc Nephrol 2018; 13:422-428. [PMID: 29440119 PMCID: PMC5967676 DOI: 10.2215/cjn.09630917] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND and objectives Our objective was to determine whether clinic BPs (taken at either a single visit or two sequential visits) are inferior to ambulatory BPs in their ability to discriminate risk of adverse outcomes in children with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We included 513 participants of the CKD in Children Study who had clinic BPs and 24-hour ambulatory BP monitoring performed during similar timeframes. Predictors of interest were systolic BPs taken at a single visit or two repeated visits within a 1-year period compared with mean wake and sleep systolic ambulatory BPs. Outcomes were left ventricular hypertrophy and ESKD. We determined the ability for each BP parameter to provide risk discrimination using c statistics. RESULTS During mean follow-up of 3.5 years, 123 participants developed ESKD. In cross-sectional unadjusted analysis, every 0.1 increase in systolic BP index was associated with a 2.0 times higher odds of left ventricular hypertrophy (95% confidence interval, 1.5 to 2.8) by clinic BPs versus 1.8 times higher odds (95% confidence interval, 1.3 to 2.4) by ambulatory wake BP. The c statistic was highest for clinic BP (c=0.65; 95% confidence interval, 0.58 to 0.73) but similar to ambulatory wake BP (c=0.64; 95% confidence interval, 0.57 to 0.71) for the discrimination of left ventricular hypertrophy. In longitudinal unadjusted analysis, every 0.1 increase in systolic BP index was associated with a higher risk of ESKD using repeated clinic (hazard ratio, 1.5; 95% confidence interval, 1.3 to 1.8) versus ambulatory wake BP (hazard ratio, 1.6; 95% confidence interval, 1.3 to 2.0). Unadjusted c statistics were the same for wake (c=0.61; 95% confidence interval, 0.56 to 0.67) and clinic systolic BPs (c=0.61; 95% confidence interval, 0.55 to 0.66) for discriminating risk of ESKD. CONCLUSIONS Clinic BPs taken in a protocol-driven setting are not consistently inferior to ambulatory BP in the discrimination of BP-related adverse outcomes in children with CKD.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine
- Division of Pediatric Nephrology, Department of Pediatrics, and
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Bradley A. Warady
- Division of Pediatric Nephrology, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
| | - Susan L. Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Barbara A. Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Mark M. Mitsnefes
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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23
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Ambulatory Blood Pressure Monitoring in Children and Adolescents: a Review of Recent Literature and New Guidelines. Curr Hypertens Rep 2017; 19:96. [DOI: 10.1007/s11906-017-0791-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Updated Guideline May Improve the Recognition and Diagnosis of Hypertension in Children and Adolescents; Review of the 2017 AAP Blood Pressure Clinical Practice Guideline. Curr Hypertens Rep 2017; 19:84. [DOI: 10.1007/s11906-017-0780-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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25
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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: 1865] [Impact Index Per Article: 266.4] [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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26
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Ristovski-Kornic D, Stefanović A, Kotur-Stevuljević J, Zeljković A, Spasojević-Kalimanovska V, Vekić J, Miljković M, Paripović D, Peco-Antić A, Jelić-Ivanović Z. Association of Myeloperoxidase and the Atherogenic Index of Plasma in Children with End-Stage Renal Disease. J Med Biochem 2017; 36:23-31. [PMID: 28680346 PMCID: PMC5471656 DOI: 10.1515/jomb-2016-0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study was to explore oxidative stress status, especially the enzyme myeloperoxidase in children with end-stage renal disease. Also, we investigated possible associations between the atherogenic index of plasma and these parameters. METHODS Lipid status parameters, oxidative stress status parameters, and myeloperoxidase concentration were measured in the sera of 20 children in the last stage of chronic renal disease (ESRD) and 35 healthy children of matching age and sex. The Atherogenic Index of Plasma (AIP) was calculated according to the appropriate equation. RESULTS We did not find any significant differences in myeloperoxidase concentrations between the investigated groups (p=0.394). Oxidative stress parameters were, however, significantly higher in the patient group (p<0.001), as well as the atherogenic index of plasma (p<0.001). Myeloperoxidase concentration and advanced oxidation protein product (AOPP) concentration were independently associated with increased AIP in the patient group (p<0.05). CONCLUSIONS Changes in AIP in children with ERSD are associated with the oxidative stress status and myeloper-oxidase concentration.
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Affiliation(s)
- Danijela Ristovski-Kornic
- Health Center Pančevo, Serbia
- Danijela Ristovski Kornic Health Center Pančevo, Serbia Miloša Obrenovića 4-6 26000 Pančevo, Phone: (+38164)158-34-34 Serbia e-mail:
| | - Aleksandra Stefanović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jelena Kotur-Stevuljević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Zeljković
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - Jelena Vekić
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Milica Miljković
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Dušan Paripović
- Department of Nephrology, University Children’s Hospital, Belgrade, Serbia
| | - Amira Peco-Antić
- Department of Nephrology, University Children’s Hospital, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Zorana Jelić-Ivanović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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27
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Peterson CG, Miyashita Y. The Use of Ambulatory Blood Pressure Monitoring As Standard of Care in Pediatrics. Front Pediatr 2017; 5:153. [PMID: 28713799 PMCID: PMC5492637 DOI: 10.3389/fped.2017.00153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertension (HTN) is a significant global health problem, responsible for 7.5 million deaths each year worldwide. The prevalence of HTN is increasing in the pediatric population likely attributed to the increase in childhood obesity. Recent work has also shown that blood pressure (BP) tends to track from childhood to adulthood including BP-related target organ damage. In the last 25-30 years, pediatric use of ambulatory blood pressure monitoring (ABPM) has been expanding mainly in the setting of initial elevated BP measurement evaluation, HTN therapy efficacy follow-up, and renal disease. However, there are many clinical areas where ABPM could potentially be used but is currently underutilized. This review summarizes the current knowledge and the uses of pediatric ABPM and explores clinical areas where it can be very useful both to detect HTN and its longitudinal follow-up. And thus, ABPM could serve as a critical tool to potentially prevent early cardiovascular mortality and morbidity in wide variety of populations. With solid data to support ABPM's superiority over clinic BP measurements and these clinical areas for its expansion, ABPM should now be part of standard of care in BP evaluation and management in pediatrics.
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Affiliation(s)
- Caitlin G Peterson
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Yosuke Miyashita
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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28
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Woroniecki RP, Kahnauth A, Panesar LE, Supe-Markovina K. Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review. Front Pediatr 2017; 5:101. [PMID: 28553631 PMCID: PMC5425592 DOI: 10.3389/fped.2017.00101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/20/2017] [Indexed: 12/17/2022] Open
Abstract
Adults with arterial hypertension (HTN) have stroke, myocardial infarction, end-stage renal disease (ESRD), or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes "hard outcomes" observed in adults. Left ventricular hypertrophy (LVH) or an anatomic and pathologic increase in left ventricular mass (LVM) in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered "the gold standard" for LVM and LVH determination, pediatric data are limited to "special populations": ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.
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Affiliation(s)
- Robert P Woroniecki
- Division of Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA
| | | | - Laurie E Panesar
- Division of Pediatric Cardiology, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA
| | - Katarina Supe-Markovina
- Division of Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA
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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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Harris KC, Benoit G, Dionne J, Feber J, Cloutier L, Zarnke KB, Padwal RS, Rabi DM, Fournier A. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension. Can J Cardiol 2016; 32:589-97. [DOI: 10.1016/j.cjca.2016.02.075] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 12/31/2022] Open
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Fülöp T, Dixit MP. Hypertension and End-Organ Damage in Children--Is the Picture Less Fuzzy Now? J Clin Hypertens (Greenwich) 2015; 17:767-9. [DOI: 10.1111/jch.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tibor Fülöp
- Division of Nephrology; Department of Internal Medicine; University of Mississippi Medical Center; Jackson MS
| | - Mehul P. Dixit
- Division of Pediatric Nephrology; Department of Pediatrics; University of Mississippi Medical Center; Jackson MS
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