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Ganji V, Sowganthikashri A, Taranikanti M, Kalpana M, Madhusudhan U, Gaur A, John NA. Arterial stiffness as a screening tool for cardiovascular risk in health and disease. J Family Med Prim Care 2024; 13:3005-3010. [PMID: 39228619 PMCID: PMC11368296 DOI: 10.4103/jfmpc.jfmpc_1563_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/30/2023] [Accepted: 02/02/2024] [Indexed: 09/05/2024] Open
Abstract
Background Cardiovascular diseases (CVD) account for approximately one-third of all deaths worldwide. The incidence of cardiovascular events such as myocardial infraction has been reported to be progressively increasing with age, especially with existing comorbidities such as hypertension, diabetes and obesity. Assessing arterial stiffness indices may serve as a screening tool in identification of population at risk of cardiovascular diseases and assist in implementation of preventive measures and early treatment in this population. Objectives To measure and compare the arterial stiffness indices in healthy adults with diabetes, hypertension and obesity. Methods A total of 184 adults in the age group of 30-50 years were included in the study who were divided into 4 groups: Group I (n = 64) (diabetic), group II (n = 40) (hypertensives), group III (n = 40) (obese) and group IV (n = 40) (control). The arterial stiffness indices were measured by using a certified oscillometric device in all the participants. Results The arterial stiffness indices were assessed by using a certified oscillometric device in all the participants. The mean values of right baPWV and left baPWV are found to be significantly higher in hypertensive subjects compared with obese, diabetic and healthy controls. Conclusion The pulse wave velocity, ASI and pulse pressure serve as independent predictors of cardiovascular mortality and outcomes in hypertension, diabetes and obesity as well as healthy individuals.
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Affiliation(s)
- Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - A Sowganthikashri
- MBBS II Year Student, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - M Kalpana
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - U Madhusudhan
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - Nitin A. John
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
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Pilz N, Heinz V, Ax T, Fesseler L, Patzak A, Bothe TL. Pulse Wave Velocity: Methodology, Clinical Applications, and Interplay with Heart Rate Variability. Rev Cardiovasc Med 2024; 25:266. [PMID: 39139426 PMCID: PMC11317333 DOI: 10.31083/j.rcm2507266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 08/15/2024] Open
Abstract
Pulse wave velocity (PWV) has been established as a promising biomarker in cardiovascular diagnostics, providing deep insights into vascular health and cardiovascular risk. Defined as the velocity at which the mechanical wave propagates along the arterial wall, PWV represents a useful surrogate marker for arterial vessel stiffness. PWV has garnered clinical attention, particularly in monitoring patients suffering from vascular diseases such as hypertension and diabetes mellitus. Its utility extends to preventive cardiology, aiding in identifying and stratifying cardiovascular risk. Despite the development of various measurement techniques, direct or indirect tonometry, Doppler ultrasound, oscillometric analysis, and magnetic resonance imaging (MRI), methodological variability and lack of standardization lead to inconsistencies in PWV assessment. In addition, PWV can be estimated through surrogate parameters, such as pulse arrival or pulse transit times, although this heterogeneity limits standardization and, therefore, its clinical use. Furthermore, confounding factors, such as variations in sympathetic tone, strongly influence PWV readings, thereby necessitating careful control during assessments. The bidirectional relationship between heart rate variability (HRV) and PWV underscores the interplay between cardiac autonomic function and vascular health, suggesting that alterations in one could directly influence the other. Future research should prioritize the standardization and increase comparability of PWV measurement techniques and explore the complex physiological variables influencing PWV. Integrating multiple physiological parameters such as PWV and HRV into algorithms based on artificial intelligence holds immense promise for advancing personalized vascular health assessments and cardiovascular care.
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Affiliation(s)
- Niklas Pilz
- Charité – Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, 10117 Berlin, Germany
- Charité – Universitätsmedizin Berlin, Institute of Translational Physiology, 10117 Berlin, Germany
| | - Viktor Heinz
- Charité – Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, 10117 Berlin, Germany
| | - Timon Ax
- Department of Ophthalmology, Saarland University Medical Center, 66421 Homburg, Germany
- School of Medicine, Western Sydney University, Sydney, NSW 2000, Australia
| | - Leon Fesseler
- Charité – Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, 10117 Berlin, Germany
| | - Andreas Patzak
- Charité – Universitätsmedizin Berlin, Institute of Translational Physiology, 10117 Berlin, Germany
| | - Tomas Lucca Bothe
- Charité – Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, 10117 Berlin, Germany
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Başaran C, Erfidan G, Özdemir-Şimşek Ö, Arslansoyu-Çamlar S, Alaygut D, Mutlubaş F, Karadeniz C, Dündar BN, Kasap-Demir B. Pulse Wave Analysis in Obese Children with and without Metabolic Syndrome. J Clin Res Pediatr Endocrinol 2023; 15:397-405. [PMID: 37470253 PMCID: PMC10683538 DOI: 10.4274/jcrpe.galenos.2023.2022-10-21] [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: 10/31/2022] [Accepted: 07/18/2023] [Indexed: 07/21/2023] Open
Abstract
Objective To compare pulse wave analysis (PWA) of obese children with and without metabolic syndrome (MS) with healthy, non-obese children and to evaluate the association between PWA findings and additional risk factors present in children with MS and obesity. Methods From the obese patients examined between June 2019 and June 2021, 41 patients with MS, 36 obese patients without MS, and 34 healthy non-obese children of similar age and gender were evaluated retrospectively. Anthropometric measurements, biochemical evaluation, 24-hour ambulatory blood pressure (BP) measurement (ABPM), left ventricular mass index (LVMI) and PWA measurements were compared. Results When the three groups were compared, weight standard deviation score (SDS), height SDS and body mass index SDS were all significantly higher in the MS group (p<0.05). The following measurements were significantly higher in both MS and non-MS obese patients compared to the control group: from ABPM measures, the systolic and mean arterial pressure BP SDSs load; from PWA, the night central systolic BP, 24-hour, day and night pulse pressure values and 24-hour, day and night pulse wave velocity (PWV) rates; and from cardiac evaluations, the LVMI and relative wall thickness measurements (all p<0.05). Furthermore, the 24-hour and daytime central systolic (cSBP) and diastolic BP (cDBP) values were significantly different between the three groups, being the highest in the MS group (p<0.05). Conclusion Obesity causes higher office, ambulatory and central BP, PWV and LVMI. However our results suggest that additional risk factors associated with MS do not contribute to these parameters, except for 24-hour and daytime cSBP and cDBP values.
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Affiliation(s)
- Cemaliye Başaran
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Gökçen Erfidan
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Özgür Özdemir-Şimşek
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Seçil Arslansoyu-Çamlar
- University Health Sciences Turkey, İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Demet Alaygut
- University Health Sciences Turkey, İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Fatma Mutlubaş
- University Health Sciences Turkey, İzmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, İzmir, Turkey
| | - Cem Karadeniz
- İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatrics, Division of Cardiology, İzmir, Turkey
| | - Bumin Nuri Dündar
- İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatrics, Division of Endocrinology, İzmir, Turkey
| | - Belde Kasap-Demir
- University Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatrics, Division of Nephrology, İzmir, Turkey
- İzmir Katip Çelebi University Faculty of Medicine, Department of Pediatrics, Division of Nephrology and Rheumatology, İzmir, Turkey
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Kasap Demir B, Soyaltın E, Alparslan C, Demircan T, Arslansoyu Çamlar S, Alaygut D, Mutlubaş F, Öncel EP, Yavaşcan Ö, Dündar BN, Karadeniz C. Blood pressure parameters affecting ventricular repolarization in obese children. Pediatr Nephrol 2023; 38:3359-3367. [PMID: 37140711 DOI: 10.1007/s00467-023-05971-5] [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: 01/26/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Ventricular repolarization (VR) increases the risk of sudden cardiac death due to ventricular arrhythmia. We aimed to evaluate the blood pressure (BP) parameters affecting VR in obese children. METHODS Obese (BMI ≥ 95p) and healthy children ≥ 120 cm between January 2017 and June 2019 were included. Demographic and laboratory data, peripheral and central BPs evaluated by a device capable of ambulatory blood pressure monitoring (ABPM), and pulse wave analysis were assessed. Electrocardiographic ventricular repolarization indices, left ventricular mass index (LVMI), and relative wall thickness (RWT) were calculated. RESULTS A total of 52 obese and 41 control patients were included. Uric acid, triglyceride, total cholesterol, LDL, and ALT values, systolic and diastolic office BPs, 24-h, daytime and nighttime systolic and mean arterial BPs, daytime diastolic BP SDS levels, daytime and nighttime systolic loads, daytime diastolic load, 24-h, daytime and nighttime central systolic and diastolic BPs, and pulse wave velocity values were significantly higher, whereas 24-h, daytime and nighttime AIx@75 were similar between the groups. fT4 levels of obese cases were significantly lower. QTcd and Tp-ed were higher in obese patients. Although RWT was higher in obese cases, LVMI values and cardiac geometry classifications were similar. The independent factors affecting VR in obese cases were younger age and higher diastolic load at night (B = - 2.83, p = 0.010; B = 0.257, p = 0.007, respectively). CONCLUSION Obese patients have higher peripheral and central BP, arterial stiffness, and higher VR indices that develop before an increase in LVMI. It would be useful to prevent obesity from an early age and follow up nighttime diastolic load to control VR associated sudden cardiac death in obese children. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Belde Kasap Demir
- Department of Pediatrics, Division of Nephrology, Izmir Katip Çelebi University, Izmir, Turkey.
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Eren Soyaltın
- Department of Pediatrics, Division of Nephrology, Izmir Katip Çelebi University, Izmir, Turkey
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Caner Alparslan
- Department of Pediatrics, Division of Nephrology, Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
| | - Tülay Demircan
- Department of Pediatrics, Division of Cardiology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Medical Faculty, Izmir, Turkey
| | - Demet Alaygut
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Medical Faculty, Izmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
- Department of Pediatrics, Division of Nephrology, University of Health Sciences Izmir Medical Faculty, Izmir, Turkey
| | - Elif Perihan Öncel
- Department of Pediatrics, Division of Neurology, Başkent University, Ankara, Turkey
| | - Önder Yavaşcan
- Department of Pediatrics, Division of Nephrology, Istanbul Medipol University, Istanbul, Turkey
| | - Bumin Nuri Dündar
- Department of Pediatrics, Division of Endocrinology, İzmir Katip Çelebi University, İzmir, Turkey
- Department of Pediatrics, Division of Endocrinology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cem Karadeniz
- Department of Pediatrics, Division of Cardiology, University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
- Department of Pediatrics, Division of Cardiology, Izmir Katip Çelebi University, İzmir, Turkey
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Kellum CE, Kemp KM, Mrug S, Pollock JS, Seifert ME, Feig DI. Adverse childhood experiences are associated with vascular changes in adolescents that are risk factors for future cardiovascular disease. Pediatr Nephrol 2023; 38:2155-2163. [PMID: 36622441 PMCID: PMC10234926 DOI: 10.1007/s00467-022-05853-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, are associated with a higher risk of cardiovascular disease (CVD) and indicators of future CVD risk in adulthood, such as greater vascular stiffness. The impact of ACEs in adolescence is unclear, and understanding how ACEs relate to blood pressure (BP) and vascular function during early life is key for the development of prevention strategies to reduce CVD risk. We hypothesized that exposure to ACEs would be associated with changes in central hemodynamics such as increased vascular stiffness and higher BP during adolescence. METHODS This pilot study enrolled 86 adolescents recruited from the Children's of Alabama. A validated ACE questionnaire was employed, and ACEs were modeled both as a continuous variable and a categorical variable (ACE ≥ 1 vs. ACE = 0). The primary outcomes used are considered to be indicators of future cardio-renal disease risk: aortic augmentation index normalized to 75 bpm (Alx75, a surrogate for vascular stiffness), carotid-femoral PWV (m/s), and ambulatory BP patterns. RESULTS Adolescents with ACE ≥ 1 had significantly higher Alx75 (ACE: 5.2% ± 2.2 compared to no ACE: - 1.4% ± 3.0; p = 0.043). PWV only reflected this trend when adjustments were made for the body mass index. Adolescents with ACEs showed no differences in ambulatory BP patterns during the 24-h, wake, or sleep periods compared to adolescents with no ACEs. CONCLUSIONS ACEs were associated with higher AIx75 in adolescence, which is a risk factor for future CVD. Adolescence could present an opportunity for early detections/interventions to mitigate adverse cardiovascular outcomes in adulthood. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Cailin E Kellum
- Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Keri M Kemp
- Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Jennifer S Pollock
- Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA.
| | - Michael E Seifert
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Daniel I Feig
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
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Mihuta MS, Paul C, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Stoian D. Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children. Biomedicines 2023; 11:1841. [PMID: 37509481 PMCID: PMC10376407 DOI: 10.3390/biomedicines11071841] [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: 06/01/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.
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Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andreea Borlea
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Dana Stoian
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Tran AH, Urbina EM. Is There a Role for Imaging Youth at Risk of Atherosclerosis? Curr Atheroscler Rep 2023; 25:119-126. [PMID: 36848015 DOI: 10.1007/s11883-023-01089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular (CV) risk factors such as dyslipidemia, hypertension, diabetes, and obesity are associated with an increased risk for CV events in adults. Noninvasive measures of vascular health are associated with these CV events and can potentially help risk stratify children with CV risk factors. The purpose of this review is to summarize recent literature regarding vascular health in children with cardiovascular risk factors. RECENT FINDINGS Adverse changes in pulse wave velocity, pulse wave analysis, arterial distensibility, and carotid intima-media thickness are seen in children with CV risk factors supporting potential utility in risk stratification. Assessing vascular health in children can be challenging due to growth-related changes in vasculature, multiple assessment modalities, and differences in normative data. Vascular health assessment in children with cardiovascular risk factors can be a valuable tool for risk stratification and help identify opportunities for early intervention. Future areas of research include increasing normative data, improving conversion of data between different modalities, and increasing longitudinal studies in children linking childhood risk factors to adult CV outcomes.
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Affiliation(s)
- Andrew H Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7002, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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Samuel JP, Bell CS, Samuels JA, Rajan C, Walton AK, Green C, Tyson JE. N-of-1 Trials vs. Usual Care in Children With Hypertension: A Pilot Randomized Clinical Trial. Am J Hypertens 2023; 36:126-132. [PMID: 36227203 DOI: 10.1093/ajh/hpac117] [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: 08/11/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood pressure (BP) is often inadequately controlled in children treated for hypertension, and personalized (n-of-1) trials show promise for tailoring treatment choices. We assessed whether patients whose treatment choices are informed by an n-of-1 trial have improved BP control compared to usual care. METHODS A randomized clinical trial was conducted in a pediatric hypertension clinic in Houston from April 2018 to September 2020. Hypertensive adolescents and young adults 10-22 years old were randomized 1:1 to a strategy of n-of-1 trial using ambulatory BP monitoring to inform treatment choice or usual care, with treatment selected by physician preference. The primary outcome was the proportion of patients with ambulatory BP control at 6 months in a Bayesian analysis. RESULTS Among 49 participants (23 randomized to n-of-1 trials and 26 to usual care), mean age was 15.6 years. Using skeptical priors, we found a 69% probability that n-of-1 trials increased BP control at 6 months (Bayesian odds ratio (OR) 1.24 (95% credible interval (CrI) 0.51, 2.97), and 74% probability using neutral informed priors (OR 1.45 (95% CrI 0.48, 4.53)). Systolic BP was reduced in both groups, with a 93% probability of greater reduction in the n-of-1 trial group (mean difference between groups = -3.6 mm Hg (95% CrI -8.3, 1.28). There was no significant difference in side effect experience or caregiver satisfaction. CONCLUSIONS Among hypertensive adolescents and young adults, n-of-1 trials with ambulatory BP monitoring likely increased the probability of BP control. A large trial is needed to assess their use in clinical practice. CLINICALTRIALS.GOV NCT03461003. CLINICAL TRIAL REGISTRY ClinicalTrials.gov; NCT03461003.
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Affiliation(s)
- Joyce P Samuel
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
| | - Cynthia S Bell
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
| | - Joshua A Samuels
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
| | - Celin Rajan
- UTHealth School of Public Health, Houston, Texas, USA
| | - Adrienne K Walton
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
| | - Charles Green
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
| | - Jon E Tyson
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA
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Mihuta MS, Stoian D, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Paul C. Evaluating the Arterial Stiffness as a Useful Tool in the Management of Obese Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020183. [PMID: 36832311 PMCID: PMC9955158 DOI: 10.3390/children10020183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
Childhood obesity speeds up the development of arterial stiffness and progressively increases the values of arterial pressure. The purpose of this study is to investigate the value of using pulse wave analysis (PWA) to measure arterial stiffness as a sign of vascular wall impairment in obese children. The research was focused on 60 subjects: 33 obese and 27 normal-weight. Ages ranged from 6 to 18 years old. PWA includes parameters such as pulse wave velocity (PWV), augmentation index (AIx), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP), heart rate, and central pulse pressure (cPP). The device used was a Mobil-O-Graph. Blood parameters were taken from the subject's medical history, not older than 6 months. A high BMI and a large waist circumference are linked to a high PWV. The levels of LDL-c, triglycerides (TG), non-HDL-c, TG/HDL-c ratio, and total cholesterol-HDL-c ratio significantly correlate to PWV, SBP, and cSBP. Alanine aminotransferase is a reliable predictor of PWV, AIx, SBP, DBP, and cDBP, while aspartate aminotransferase is a significant predictor of AIx, mean arterial pressure (MAP), cSBP, and cPP. 25-OH-Vitamin D negatively correlates with PWV, SBP, and MAP and significantly predicts the MAP. Cortisol and TSH levels are not significant to arterial stiffness in obese children without specific comorbidities and neither is fasting glucose in obese children without impaired glucose tolerance. We conclude that PWA contributes valuable data regarding patients' vascular health and should be considered a reliable tool in the management of obese children.
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Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dana Stoian
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Andreea Borlea
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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10
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Evaluation of Arterial Stiffness and Carotid Intima-Media Thickness in Children with Primary and Renal Hypertension. Pediatr Cardiol 2023; 44:54-66. [PMID: 36169696 DOI: 10.1007/s00246-022-03012-w] [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: 07/16/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
Abstract
Hypertension is an increasing disease in children and the risk of endothelial damage and target organ damage increases in the presence of additional risk factors such as obesity. In our study, the effect of hypertension on early atherosclerotic changes and target organ damage in children was investigated. Twenty four-hour ambulatory pulse wave analysis was performed by oscillometric method in 71 children aged 8-18 years, 17 of whom were diagnosed with primary hypertension without obesity, 18 had both primary hypertension and obesity, and 16 had renal hypertension. Twenty healthy normotensive children were included as the control group. Carotid intima-media thickness (CIMT) and Left Ventricular Mass Index were measured. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in the primary hypertension group compared to controls (p = 0.001, p = 0.005, p = 0.001, p = 0.009, respectively), cSBP was higher in the renal hypertension group than the control group (p = 0.018). There was no difference between the groups in terms of pulse wave analysis parameters, CIMT, or left ventricular mass index (p > 0.05). Pulse wave velocity was positively correlated with SBP, DBP, cSBP, cDBP (p < 0.001). Augmentation index was positively correlated with DBP and cDBP (p = 0.01, p = 0.002, respectively). Our findings show that high blood pressure is associated with arterial stiffness and target organ damage beginning in childhood. The detection of early atherosclerotic vascular changes using pulse wave analysis allows to take necessary precautions such as lifestyle changes to prevent target organ damage in hypertensive children.
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11
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Mora-Urda AI, Martín-Almena FJ, Montero López MDP. Relationship between the Dietary Inflammatory Index and Cardiovascular Health among Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15706. [PMID: 36497778 PMCID: PMC9735952 DOI: 10.3390/ijerph192315706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the relationship between the Dietary Inflammatory Index (DII®) and cardiovascular health indicators in children. METHODS The sample consisted of 365 schoolchildren aged 8 to 12 from the Region of Madrid. Anthropometric and hemodynamic measurements were collected. Variables relating to habits and lifestyles, parental level of education, and data on their diet, through three 24 h food recall surveys, were also collected. The diet quality indicators considered are the DII based on 25 nutrients and the KIDMED index. RESULTS Children with a more pro-inflammatory diet came from families with lower levels of parental education (p < 0.05). Predictive models show that in the group with a more pro-inflammatory diet (>P50), the likelihood of developing hypertension in childhood is 2.1 times higher (OR = 2.085 (1.107-3.927)) and they have more than twice the risk of developing obesity (OR = 2.3) or developing obesity and hypertension simultaneously (OR = 1.290 (1.316-3.985)). Furthermore, predictive models showed that the children with a pro-inflammatory diet (>P50) had higher values for BFM% (β = 1.957; p = 0.026) and BMI (β = 0.015; p = 0.012) than children with a lower inflammatory diet ( CONCLUSIONS Higher values on the DII are related to poorer nutritional status and cardiovascular health in childhood. Thus, a pro-inflammatory diet is also associated with a lower socio-economic level and poorer diet quality.
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Affiliation(s)
- Ana Isabel Mora-Urda
- Departamento de Didácticas Específicas, Facultad de Formación del Profesorado, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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12
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A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents. Pediatr Exerc Sci 2022:1-12. [PMID: 36150705 DOI: 10.1123/pes.2022-0029] [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: 02/16/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents. METHODS Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5-17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies. RESULTS Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality. CONCLUSION While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.
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13
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Haley JE, Woodly SA, Daniels SR, Falkner B, Ferguson MA, Flynn JT, Hanevold CD, Hooper SR, Ingelfinger JR, Khoury PR, Lande MB, Martin LJ, Meyers KE, Mitsnefes M, Becker RC, Rosner BA, Samuels J, Tran AH, Urbina EM. Association of Blood Pressure-Related Increase in Vascular Stiffness on Other Measures of Target Organ Damage in Youth. Hypertension 2022; 79:2042-2050. [PMID: 35762327 PMCID: PMC9378473 DOI: 10.1161/hypertensionaha.121.18765] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension-related increased arterial stiffness predicts development of target organ damage (TOD) and cardiovascular disease. We hypothesized that blood pressure (BP)-related increased arterial stiffness is present in youth with elevated BP and is associated with TOD. METHODS Participants were stratified by systolic BP into low- (systolic BP <75th percentile, n=155), mid- (systolic BP ≥80th and <90th percentile, n=88), and high-risk BP categories (≥90th percentile, n=139), based on age-, sex- and height-specific pediatric BP cut points. Clinic BP, 24-hour ambulatory BP monitoring, anthropometrics, and laboratory data were obtained. Arterial stiffness measures included carotid-femoral pulse wave velocity and aortic stiffness. Left ventricular mass index, left ventricular systolic and diastolic function, and urine albumin/creatinine were collected. ANOVA with Bonferroni correction was used to evaluate differences in cardiovascular risk factors, pulse wave velocity, and cardiac function across groups. General linear models were used to examine factors associated with arterial stiffness and to determine whether arterial stiffness is associated with TOD after accounting for BP. RESULTS Pulse wave velocity increased across groups. Aortic distensibility, distensibility coefficient, and compliance were greater in low than in the mid or high group. Significant determinants of arterial stiffness were sex, age, adiposity, BP, and LDL (low-density lipoprotein) cholesterol. Pulse wave velocity and aortic compliance were significantly associated with TOD (systolic and diastolic cardiac function and urine albumin/creatinine ratio) after controlling for BP. CONCLUSIONS Higher arterial stiffness is associated with elevated BP and TOD in youth emphasizing the need for primary prevention of cardiovascular disease.
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Affiliation(s)
| | - Shalayna A Woodly
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | | | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, WA (J.T.F., C.D.H.)
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | - Coral D Hanevold
- Department of Pediatrics, University of Washington, Seattle, WA (J.T.F., C.D.H.)
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | | | | | - Philip R Khoury
- Rady Children's Hospital San Diego, CA (J.E.H.)
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | - Marc B Lande
- University of Rochester Medical Center, Rochester, NY (M.B.L.)
| | - Lisa J Martin
- Rady Children's Hospital San Diego, CA (J.E.H.)
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
| | | | | | - Joshua Samuels
- University of Texas Health Sciences Center, Houston (J.S.)
| | - Andrew H Tran
- Nationwide Children's Hospital, Columbus, OH (A.H.T.)
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (S.A.W., P.R.K., L.J.M., M.M., E.M.U.)
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14
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Disparities between determinants of impaired vascular structure and function in young people with primary hypertension: a systematic review. J Hypertens 2022; 40:1369-1379. [PMID: 35762477 DOI: 10.1097/hjh.0000000000003155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Early effects of primary hypertension on arterial structure and function in children and young people (CYP) and their determinants remain elusive. We aimed to review independent determinants of carotid intima-media thickness (cIMT), carotid wall cross-sectional area (WCSA) and carotid-femoral pulse wave velocity (cfPWV) in CYP with primary hypertension. METHODS We performed a systematic review of studies reporting multivariable analysis of cfPWV, cIMT and WCSA in CYP (up to 25 years of age) with primary hypertension. Literature search was performed in PubMed database and 13, 12 and two articles including 3860 (age range 4-25 years, 50% male individuals), 2038 children (5-25 years, 55% male individuals) and 136 children (5-17 years, 85% male individuals) were selected for final analysis of cfPWV, cIMT and WCSA, respectively. RESULTS Ninety and 86% of the studies reported higher cfPWV and cIMT in CYP with elevated blood pressure (BP) compared with normotensive controls. Different indices of BP were positively associated with cfPWV in 92% of studies, whereas BMI showed association in 31%. Carotid IMT associated with BP indices in 50% and with BMI in 25% of the studies. WCSA was studied longitudinally and its improvement associated with decrease in measures of central obesity. CONCLUSION We found a disparity between the determinants of structural and functional impairment of arterial tree in CYP with primary hypertension. In contrast to cIMT and WCSA, increase of cfPWV is almost exclusively determined by BP.
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15
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Evaluation of arterial stiffness and central blood pressure by oscillometric method in normotensive offspring of hypertensive parents. Cardiol Young 2022; 32:888-895. [PMID: 34387175 DOI: 10.1017/s1047951121003206] [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: 11/06/2022]
Abstract
Children with a family history of hypertension have higher blood pressure and hypertensive pathophysiological changes begin before clinical findings. Here, the presence of arterial stiffness was investigated using central blood pressure measurement and pulse wave analysis in normotensive children with at least one parent with essential hypertension. Twenty-four-hour ambulatory pulse wave analysis monitoring was performed by oscillometric method in a study group of 112 normotensive children of hypertensive parents aged between 7 and 18 comparing with a control group of 101 age- and gender-matched normotensive children of normotensive parents. Pulse wave velocity, central systolic and diastolic blood pressure, systolic, diastolic and mean arterial blood pressure values were higher in the study group than the control group (p < 0.001, p = 0.002, p = 0.008, p = 0.001, p = 0.005, p = 0.001, p = 0.001, respectively). In all age groups (7-10, 11-14, and 15-18 years), pulse wave velocity was higher in the study group than the control group (p < 0.001). Pulse wave velocity was higher in children whose both parents are hypertensive compared to the children whose only mothers are hypertensive (p = 0.011). Pulse wave velocity values were positively correlated with age, weight, height, and body mass index (p < 0.05). Higher pulse wave velocity, central systolic and diastolic blood pressure values detected in the study group can be considered as early signs of hypertensive vascular changes. Pulse wave analysis can be a reliable, non-invasive, and reproducible method that can allow taking necessary precautions regarding lifestyle to prevent disease and target organ damage by detecting early hypertensive changes in genetically risky children.
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16
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Mannemuddhu SS, Macumber I, Samuels JA, Flynn JT, South AM. When Hypertension Grows Up: Implications for Transitioning Care of Adolescents and Young Adults With Hypertension From Pediatric to Adult Health Care Providers. Adv Chronic Kidney Dis 2022; 29:263-274. [PMID: 36084973 DOI: 10.1053/j.ackd.2021.11.005] [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: 07/15/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Hypertension (HTN) is an important cause of morbidity and mortality in children as well as adults. HTN and related adverse cardiovascular health develop and progress on a continuum across an individual's life course. Pediatric HTN, or even isolated elevated blood pressure as a child, increases the risk of sustained HTN and cardiovascular disease in later adulthood. Transitioning the care of adolescents and young adults who have HTN is an important but unmet health care need that could potentially have a dramatic effect on mitigating the risk of cardiovascular disease in adulthood. However, very little has been published about the transition process in this population, and considerable gaps in the field remain. We discuss the epidemiology, etiology, and management approach in youth with HTN and how they differ from adults. We contextualize HTN and cardiovascular health on a continuum across the life course. We discuss key considerations for the transition process for adolescents and young adults with HTN including the major barriers that exist. Finally, we review key immediate health care needs that are particularly important around the time of the transfer of care.
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Affiliation(s)
- Sai Sudha Mannemuddhu
- East Tennessee Children's Hospital, Knoxville, TN; Department of Medicine, University of Tennessee Health Science Center-College of Medicine, Knoxville, TN
| | - Ian Macumber
- Department of Pediatrics, Keck School of Medicine, Division of Nephrology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joshua A Samuels
- Department of Pediatrics, Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Division of Nephrology, Seattle Children's Hospital, Seattle, WA.
| | - Andrew M South
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, NC; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC; Cardiovascular Sciences Center, Wake Forest School of Medicine, Winston Salem, NC
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17
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Golob Jančič S, Močnik M, Švigelj M, Marčun Varda N. Body Composition and Cardiovascular Risk Factors in a Paediatric Population. CHILDREN (BASEL, SWITZERLAND) 2022; 9:603. [PMID: 35626780 PMCID: PMC9139520 DOI: 10.3390/children9050603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
The aim of our study was to evaluate associations between body composition parameters and several clinical parameters. A total of 206 children and adolescents (120 male, 86 female) were prospectively included. Body impedance measurement was performed in all participants. During the hospital work-up, several clinical parameters such as anthropometric measurements and laboratory and ultrasound findings were obtained and correlated to body composition parameters. There was a significant association between body composition parameters and anthropometric measurements, systolic blood pressure, insulin levels, serum creatinine, urate, liver function tests, triglycerides, cholesterols and apolipoproteins, homocysteine, vitamin D and proteins in 24-h urine. Body composition differed by gender, between participants with and without hepatic steatosis and between patients with and without left ventricular hypertrophy. Interestingly, body composition did not correlate with diastolic blood pressure, pulse wave velocity and intima media thickness. This study showed that several clinical parameters are associated with body composition in children. Obesity and body composition play an important role in the development of other cardiovascular risk factors and are not dependent on fat mass alone, and the latter might be used for cardiovascular risk determination.
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Affiliation(s)
- Sonja Golob Jančič
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (S.G.J.); (N.M.V.)
| | - Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (S.G.J.); (N.M.V.)
| | - Marjetka Švigelj
- Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia;
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (S.G.J.); (N.M.V.)
- Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia;
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18
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Močnik M, Golob Jančič S, Filipič M, Marčun Varda N. The Role of Urate in Cardiovascular Risk in Adolescents and Young Adults With Hypertension, Assessed by Pulse Wave Velocity. Front Cardiovasc Med 2022; 9:867428. [PMID: 35498002 PMCID: PMC9053644 DOI: 10.3389/fcvm.2022.867428] [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: 02/01/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Urate is increasingly recognized as a cardiovascular risk factor. It has been associated with hypertension, metabolic syndrome, obesity, chronic kidney disease and diabetes. Its prognostic role is less clear. The aim of our study was to evaluate the association between serum urate and pulse wave velocity, a measure of arterial stiffness in hypertensive adolescents and young adults. Methods 269 adolescents and young adults with hypertension were included in the study. From all, anthropometric, blood pressure, pulse wave velocity and serum urate measurements were made. Variables were compared between sex, participants with or without obesity and with or without elevated urate. Results In multiple regression analysis for urate as dependent variable gender and diastolic pressure were found to be statistically significant. The difference between urate levels were found between boys and girls (p < 0.001), obese and non-obese (p < 0.001); however, pulse wave velocity did not differ between hyper- and eu-uricemic group (p = 0.162). Conclusion Associations between urate, gender, diastolic blood pressure and obesity were confirmed, however, no significant associations between pulse wave velocity and urate were detected.
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Abstract
The 95th percentile of blood pressure (BP) among healthy children is the currently accepted level used to denote a hypertensive BP reading in pediatric patients. Yet, ample data have emerged showing that the detrimental effects of high BP can be demonstrated at BP levels considered normal by current guidelines. Cardiac, vascular, cognitive, and kidney effects have been shown starting at the 90th percentile in cross-sectional studies, and markers of adult cardiovascular disease appear in longitudinal cohorts whose members had modestly elevated or even normal BP as youth. This review summarizes data that support a lower threshold of concern for children and adolescents, and outlines some of the remaining questions to be answered before a lower threshold BP level could be adopted.
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Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine. Division of Nephrology, Seattle Children's Hospital, WA
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20
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Association of blood pressure, obesity and physical activity with arterial stiffness in children: a systematic review and meta-analysis. Pediatr Res 2022; 91:502-512. [PMID: 33824443 DOI: 10.1038/s41390-020-01278-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/31/2022]
Abstract
Central pulse wave velocity (cPWV) is a biomarker for cardiovascular (CV) risk and a predictor for CV events in adulthood. Alterations of arterial stiffness have also been associated with CV risk in childhood. The study aimed to systematically review and meta-analyze the association of blood pressure (BP), body mass index (BMI), and cardiorespiratory fitness (CRF) with cPWV in children. Literature search was through the databases PubMed, Web of Science, Embase and the Cochrane Register of Controlled Trials. Twenty-two articles were included in the systematic review and eight articles in the meta-analysis. Higher systolic and diastolic BP were associated with higher cPWV (pooled estimated effect size (ES) 0.02 (95% CI: 0.012-0.027; P < 0.001), and ES 0.02 (95% CI: 0.011-0.029; P < 0.001); respectively). Higher BMI correlated with higher cPWV (ES 0.025 (95% CI: 0.013-0.038; P < 0.001)). CRF was inversely associated with cPWV (ES -0.033 (95% CI: -0.055 to -0.011; P = 0.002)). In children, higher BP and BMI are already related to increased cPWV, and enhanced CRF may be a preventive strategy to counteract development of CV disease later in life. IMPACT: This meta-analysis suggests that elevated blood pressure and body mass index in childhood correlate with increased central pulse wave velocity. Children with higher cardiorespiratory fitness appear to have favorably lower arterial stiffening. Elevated blood pressure and altered arterial stiffness originate early in life and childhood risk stratification as well as timely initiation of exercise treatment may help counteract development of manifest cardiovascular disease later in life.
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21
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Hu F, Yu R, Han F, Li J, Zhou W, Wang T, Zhu L, Huang X, Bao H, Cheng X. Does body mass index or waist-hip ratio correlate with arterial stiffness based on brachial-ankle pulse wave velocity in Chinese rural adults with hypertension? BMC Cardiovasc Disord 2021; 21:573. [PMID: 34852784 PMCID: PMC8638469 DOI: 10.1186/s12872-021-02390-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relationship between obesity indices and arterial stiffness (AS) has not been fully discovered nor has it been studied in depth in large hypertensive patient populations. The aim of this study was to explore the association between body mass index (BMI) and waist-hip ratio (WHR) levels and AS based on brachial-ankle pulse wave velocity (baPWV) in Chinese rural adults with hypertension. METHODS This cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. BMI was calculated as the body weight in kilograms divided by the square of the height in meters (kg/m2). Central obesity was defined as WHR ≥ 0.9 for males and ≥ 0.85 for females. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV). RESULTS The prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS (adjusted-OR per SD increase: 0.74, 95% CI 0.67-0.81, P < 0.001). When BMI was instead treated as a categorical variable divided into tertiles, the same relationship was observed (P for trend < 0.001). Inversely, WHR levels were positively associated with the prevalence of increased AS (adjusted-OR per SD increase: 1.25, 95% CI 1.14-1.36, P < 0.001). Compared to subjects without central obesity, those with central obesity had a higher prevalence of increased AS (adjusted-OR: 1.52, 95% CI 1.28-1.81, P < 0.001). Linear regression models indicated similar results in the correlation between BMI or WHR levels and baPWV levels (adjusted-β per SD increase: - 0.57, 95% CI - 0.68 to - 0.46, P < 0.001; adjusted-β per SD increase: 4.46, 95% CI 3.04-5.88, P < 0.001). There were no interactions in terms of age and blood pressure on the relationship between BMI or WHR levels and the prevalence of increased AS or baPWV levels. CONCLUSION There was an inverse relationship between BMI levels and increased AS or baPWV levels, whereas WHR levels and central obesity were positively associated with increased AS or baPWV levels in Chinese rural adults with hypertension.
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Affiliation(s)
- Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Rihua Yu
- Department of General Practice Medicine, Zhentou Town Health Center, Wuyuan, Jiangxi, China
| | - Fengyu Han
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Juan Li
- The College of Pharmacy, Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zhou
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tao Wang
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lingjuan Zhu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China.
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China.
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China.
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China.
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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22
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Marčun Varda N, Močnik M. Pulse Wave Velocity, Central Haemodynamic Parameters, and Markers of Kidney Function in Children. Kidney Blood Press Res 2021; 47:43-49. [PMID: 34657030 DOI: 10.1159/000519340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular diseases. Studies in adults have demonstrated the association between mildly decreased kidney function or even normal values of markers of kidney function to pulse wave velocity (PWV), a measure of arterial stiffness and a predictor of cardiovascular events. Our study aimed to evaluate associations between markers of CKD, PWV, and central haemodynamic parameters in children and adolescents at risk of subclinical kidney damage. METHODS 182 children and adolescents with hypertension, obesity, or hypercholesterolaemia (risk factors for subclinical kidney damage) were included in the study. The subjects were subdivided into 4 groups comprising children and adolescents with hypertension (group 1), obesity (group 2), hypercholesterolaemia (group 3), and a group with a combination of risk factors, such as obesity-related hypertension and metabolic syndrome (group 4). The study groups were compared to a group of healthy controls (group 5). PWV was measured by applanation tonometry (SphygmoCor, SCOR-Vx, Sydney, NSW, Australia) and laboratory parameters (serum creatinine, serum cystatin C, and microalbuminuria) were collected. RESULTS Pearson's correlation coefficient demonstrated a statistically significant correlation between PWV and serum creatinine in group of all subjects (r = 0.220, p = 0.002). Further subdivision showed the correlation was significant in group 4 (r = 0.370, p = 0.002). In group 2 a correlation between PWV and cystatin C was found (r = -0.535, p = 0.009). In multiple regression analysis of all subjects with PWV as the dependent variable, age and diastolic blood pressure were statistically significant. Correlations between markers of kidney function and central haemodynamic parameters also showed significant correlations between serum creatinine and heart rate (HR) (r = -0.476, p < 0.001) as well as associated parameters (augmentation index, standardized at HR 75/min, ejection duration, and subendocardial viability ratio). CONCLUSIONS Our study demonstrated a correlation between serum creatinine and PWV in children with combined risk factors for atherosclerosis and probable subclinical kidney damage. Further prospective research is needed to confirm the findings, and thus the preventive role of PWV determination in paediatric nephrology.
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Affiliation(s)
- Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia
| | - Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia
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Liu W, Hou C, Hou M, Xu QQ, Wang H, Gu PP, Sun L, Lv HT, Ding YY. Ultrasonography to detect cardiovascular damage in children with essential hypertension. Cardiovasc Ultrasound 2021; 19:26. [PMID: 34289865 PMCID: PMC8296659 DOI: 10.1186/s12947-021-00257-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Essential hypertension in adults may begin in childhood. The damages to the heart and blood vessels in children with essential hypertension are hidden and difficult to detect. We noninvasively examined changes in cardiovascular structure and function in children with hypertension at early stage using ultrasonography. Methods All patients with essential hypertension admitted from March 2020 to May 2021 were classified into simple hypertension (group 1, n = 34) and hypertension co-existing with obesity (group 2, n = 11) isolation. Meanwhile 32 healthy children were detected as control heathly group (group 3). We used pulse-wave Doppler to measure carotid–femoral pulse wave velocity (cfPWV), intimal–medial thickness (cIMT) and distensibility of carotid artery (CD). Cardiac structure and function (left atrial diameter [LAD], left ventricular mass [LVM], LVM index [LVMI], relative wall thicknes [RWT], end-diastolic left ventricular internal diameter [LVIDd], diastolic interventricular septum thickness [IVSd], diastolic left ventricular posterior wall thickness [LVPWd], root diameter of aorta [AO], E peak, A peak, E' peak, A' peak, E/E' ratio, and E/A ratio) were measured by echocardiography. Results The cfPWV of children in group 1 and group 2 were significantly higher than healthy children in group 3. Significant differences were observed in LVM, LVMI, RWT, LVIDd, IVSd, LVPWd, LAD, A peak, E' peak, A' peak, and E/E’ among three groups. Conclusion Children and adolescents with essential hypertension demonstrate target organ damages in the heart and blood vessels.
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Affiliation(s)
- Wei Liu
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Cui Hou
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Miao Hou
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Qiu-Qin Xu
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Hui Wang
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Pei-Pei Gu
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Ling Sun
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China
| | - Hai-Tao Lv
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China.
| | - Yue-Yue Ding
- Cardiology Department, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, 215025, China.
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Climie RE, Park C, Avolio A, Mynard JP, Kruger R, Bruno RM. Vascular Ageing in Youth: A Call to Action. Heart Lung Circ 2021; 30:1613-1626. [PMID: 34275753 DOI: 10.1016/j.hlc.2021.06.516] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 12/18/2022]
Abstract
Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.
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Affiliation(s)
- R E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France.
| | - C Park
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, UCL, London, UK
| | - A Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - J P Mynard
- Heart Research, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - R Kruger
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - R-M Bruno
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France. https://twitter.com/rosam_bruno
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Övünç Hacıhamdioğlu D, Ceylan Ö, Yardımcı AH. Could arterial stiffness be early reversible target organ damage test in childhood hypertension? Anatol J Cardiol 2021; 25:496-504. [PMID: 34236325 DOI: 10.5152/anatoljcardiol.2021.67927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The recommended treatment for hypertension (HTN) in children has been revised recently. This study aimed to present the changes in target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary HTN who were managed in accordance with the 2016 European Society of Hypertension Guidelines. METHODS Patients with primary HTN included in this study were newly diagnosed, untreated, and were followed-up for a minimum of 6 months. HTN was confirmed by 24-h ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, and first morning urine albumin tocreatinine ratio. The ABPM device performed measurements such as central blood pressure (cBP) and pulse wave velocity (PWV). RESULTS Thirty-two of 104 patients were enrolled. Seventeen patients were male, and 53% were obese. Compared with pretreatment, creatinine, urea, systolic BP (SBP), diastolic BP (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z score, cDBP, and PWV z score decreased, whereas LVMI and BMI z scores were unchanged. CONCLUSION After BP improvement, while LVMI did not regress, the cSBP, cSBP z, and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of BP control on the cardiovascular system even in a short-term follow-up. Further longitudinal studies are needed for the assessment of BP control on arterial stiffness in childhood.
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Affiliation(s)
- Duygu Övünç Hacıhamdioğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Bahçeşehir University, Medical Park Göztepe Hospital; İstanbul-Turkey;Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital; İstanbul-Turkey
| | - Özben Ceylan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital; İstanbul-Turkey;Department of Pediatric Cardiology, University of Health Sciences, İstanbul Training and Research Hospital; İstanbul-Turkey
| | - Aytül Hande Yardımcı
- Department of Radiology, University of Health Sciences, İstanbul Training and Research Hospital; İstanbul-Turkey
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Matjuda EN, Engwa GA, Anye SNC, Nkeh-Chungag BN, Goswami N. Cardiovascular Risk Factors and Their Relationship with Vascular Dysfunction in South African Children of African Ancestry. J Clin Med 2021; 10:jcm10020354. [PMID: 33477761 PMCID: PMC7832309 DOI: 10.3390/jcm10020354] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022] Open
Abstract
Vascular dysfunction is known to be an initiator of the development and progression of cardiovascular diseases (CVDs). However, there is paucity of information on the relationship of vascular dysfunction with cardiovascular risk factors in children of African ancestry. This study investigated the relationship between cardiovascular risk factors and vascular function in South African children of African ancestry. A cross-sectional study on 6–9-year-old children in randomly selected rural and urban schools of the Eastern Cape Province of South Africa was conducted. General anthropometric indices were measured, followed by blood pressure (BP) measurements. The pulse wave velocity (PWV) was measured using a Vicorder. Albumin to creatinine ratio (ACR), asymmetric dimethylarginine (ADMA), 8-hydroxy-2deoxyguanosine (8-OHdG) and thiobarbituric acid reactive substance (TBARS) were assayed in urine. Children from urban settings (10.8%) had a higher prevalence of overweight/obesity than their rural counterparts (8.5%) while the prevalence of elevated/high blood pressure was higher in rural (23.2%) than urban children (19.0%). Mean arterial blood pressure (MAP) and diastolic blood pressure (DBP) increased with increasing PWV (p < 0.05). Body mass index (BMI), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) positively associated (p < 0.05) with PWV. Creatinine, albumin and ACR significantly (p < 0.005) increased with increasing ADMA. ADMA associated positively (p < 0.05) with creatinine and 8-OHdG. In conclusion, vascular dysfunction was associated with obesity, high blood pressure, oxidative stress and microalbuminuria in South African children of African ancestry.
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Affiliation(s)
- Edna N. Matjuda
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
| | - Godwill A. Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
| | - Samuel Nkeh Chungag Anye
- MBCHB Programme, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
| | - Benedicta N. Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha 5117, South Africa;
- Correspondence:
| | - Nandu Goswami
- Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, 8036 Graz, Austria;
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27
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Stabouli S, Kollios K, Nika T, Chrysaidou K, Tramma D, Kotsis V. Ambulatory hemodynamic patterns, obesity, and pulse wave velocity in children and adolescents. Pediatr Nephrol 2020; 35:2335-2344. [PMID: 32661605 DOI: 10.1007/s00467-020-04694-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent years, pulse wave velocity (PWV) has emerged as a surrogate marker of cardiovascular disease in children with cardiovascular risk factors. The aims of the present study were to identify determinants of PWV in children according to their weight status and to investigate the role of peripheral blood pressure and central hemodynamic parameters in the association between PWV and obesity. METHODS We included in the study healthy children and adolescents randomly selected from a school-based blood pressure screening study. All participants underwent ambulatory blood pressure monitoring and 24-h pulse wave analysis. RESULTS Overweight and obese children had higher 24-h PWV, 24-h peripheral and central systolic blood pressure (SBP), and cardiac output than normal weight ones. Children with both overweight and hypertension presented the highest 24-h PWV values (p < 0.001). Peripheral and central SBP, body mass index (BMI), and hemodynamic parameters, including stroke volume, cardiac output, total peripheral resistance, and cardiac index, were all associated with 24-h PWV. However, in stepwise regression analysis, 24-h peripheral and central SBP and cardiac index, but not BMI, were independent predictors of 24-h PWV. There were statistically significant differences in 24-h blood pressure and hemodynamic parameters among those on the lower and highest 24-h PWV quartile, but there were no significant differences in BMI among 24-h PWV quartile groups. CONCLUSIONS Arterial stiffness is higher in overweight and obese children in the co-presence of hypertension. Peripheral and central SBP are the main determinants of 24-h PWV independent of weight status. Graphical abstract.
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Affiliation(s)
- Stella Stabouli
- 1st Department of Pediatrics, Pediatric Nephrology Unit, Hippokratio Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece.
| | - Konstantinos Kollios
- 3rd Department of Pediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomaitsa Nika
- 3rd Department of Pediatrics, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Chrysaidou
- 1st Department of Pediatrics, Pediatric Nephrology Unit, Hippokratio Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Despoina Tramma
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM Center, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Although relatively rare in childhood, primary hypertension (PH) is thought to have originated in childhood and may be even determined perinatally. PH prevalence increases in school-age children and affects 11% of 18-year-old adolescents. Associated with metabolic risk factors, elevated blood pressure in childhood is carried into adulthood. Analysis of the phenotype of hypertensive children has revealed that PH is a complex of anthropometric and neuro-immuno-metabolic abnormalities, typically found in hypertensive adults. Children with elevated blood pressure have shown signs of accelerated biological development, which are closely associated with further development of PH, metabolic syndrome, and cardiovascular disease in adulthood. At the time of diagnosis, hypertensive children were reported to have significant arterial remodelling expressed as significantly increased carotid intima-media thickness, increased stiffness of large arteries, lower area of microcirculation, and decreased endothelial function. These changes indicate that their biological age is 4 to 5 years older than their normotensive peers. All these abnormalities are typical features of early vascular aging described in adults with PH. However, as these early vascular changes in hypertensive children are closely associated with features of accelerated biological development and neuro-immuno-metabolic abnormalities observed in older subjects, it seems that PH in childhood is not only an early vascular aging event, but also an early biological maturation phenomenon.
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Abstract
PURPOSE OF REVIEW To review the haemodynamic characteristics of paediatric hypertension. RECENT FINDINGS Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children.
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Affiliation(s)
- Ye Li
- King's College London British Heart Foundation Centre, London, UK
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Emily Haseler
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, UK.
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, UK
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
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30
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Leopold S, Zachariah JP. Pediatric Obesity, Hypertension, Lipids. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:62-77. [PMID: 33457188 PMCID: PMC7810340 DOI: 10.1007/s40746-020-00188-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The rise of the pediatric obesity pandemic over the past 40 years has sharpened focus on the management of obesity, hypertension and lipid abnormalities in children. Multiple studies demonstrate that these risk factors track from childhood into adulthood predisposing individuals to premature atherosclerotic cardiovascular disease and putting them at risk for early morbidity and mortality. RECENT FINDINGS Importantly, obesity, hypertension and lipid problems are individual risk factors that can occur independently. Multiple studies have shown that each risk factor causes target organ damage in children. Intensive and focused lifestyle modifications can improve a child's subclinical disease and decrease the risk for future morbidity. SUMMARY Childhood offers a unique opportunity at primordial and primary prevention of atherosclerotic cardiovascular disease. Clinicians must focus on targeting these highly prevalent conditions and applying lifestyle modification and then pharmacologic or surgical therapies as needed.
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Affiliation(s)
- Scott Leopold
- Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Baumgartner L, Weberruß H, Oberhoffer-Fritz R, Schulz T. Vascular Structure and Function in Children and Adolescents: What Impact Do Physical Activity, Health-Related Physical Fitness, and Exercise Have? Front Pediatr 2020; 8:103. [PMID: 32266183 PMCID: PMC7096378 DOI: 10.3389/fped.2020.00103] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
A physically active lifestyle can prevent cardiovascular disease. Exercise intervention studies in children and adolescents that aim to increase physical activity have resulted in reduced vascular wall thickening and improve cardiovascular function. Here we review the literature that explores the correlations between physical activity, health-related physical fitness, and exercise interventions with various measures of vascular structure and function in children and adolescents. While several of these studies identified improvements in vascular structure in response to physical activity, these associations were limited to studies that relied on questionnaires. Of concern, these findings were not replicated in studies featuring quantitative assessment of physical activity with accelerometers. Half of the studies reviewed reported improved vascular function with increased physical activity, with the type of vascular measurement and the way physical activity was assessed having an influence on the reported relationships. Similary, most of the studies identified in the literature report a beneficial association of health-related physical fitness with vascular structure and function. Overall, it was difficult to compare the results of these studies to one another as different methodologies were used to measure both, health-related physical fitness and vascular function. Likewise, exercise interventions may reduce both arterial wall thickness and increased vascular stiffness in pediatric populations at risk, but the impact clearly depends on the duration of the intervention and varies depending on the target groups. We identified only one study that examined vascular structure and function in young athletes, a group of particular interest with respect to understanding of cardiovascular adaptation to exercise. In conclusion, future studies will be needed that address the use of wall:diameter or wall:lumen-ratio as part of the evaluation of arterial wall thickness. Furthermore, it will be critical to introduce specific and quantitative measurements of physical activity, as intensity and duration of participation likely influence the effectiveness of exercise interventions.
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Affiliation(s)
- Lisa Baumgartner
- Institute of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Abstract
Zusammenfassung
Hintergrund
Übergewicht und Bewegungsmangel stellen bei Kindern ein Risiko für kardiovaskuläre Erkrankungen dar. Das Ziel der Studie war, den kardiovaskulären Gesundheitsstatus und die Fitness deutscher Grund- und Gesamtschülerinnen und -schüler sowie mögliche Einflussfaktoren zu erfassen.
Methodik
In einer prospektiven Querschnittsstudie wurden 357 Kinder (9,6 ± 1,7 Jahre) auf kardiovaskuläre Risikofaktoren untersucht. Die Pulswellengeschwindigkeit (PWV) als Maß für die arterielle Gefäßelastizität sowie die Fahrradergometrie zur Einschätzung der Fitness wurden bestimmt.
Ergebnisse
24 % der Kinder waren übergewichtig (Body-Mass-Index, BMI >90. Perzentile) oder adipös (BMI >97. Perzentile). Nahezu alle diese Kinder litten an einer viszeralen Adipositas (99 %). Bei Kindern mit Übergewicht/Adipositas war häufiger eine geringere Gefäßelastizität nachweisbar (PWV „standard deviation score“, SDS 0,8 ± 1,0 vs. 0,2 ± 0,9 bei Kindern ohne Übergewicht, p < 0,001; PWV-Werte >95. Perzentile 24 % vs. 3 %). Das Vorliegen von Übergewicht/Adipositas, Grundschulalter, höherer Blutdruck und niedrigeres „High Density Lipoprotein“(HDL)-Cholesterin waren unabhängige Prädiktoren für geringere Gefäßelastizität. Zudem zeigten Kinder mit Übergewicht/Adipositas einen höheren systolischen Blutdruck, ein nachteiligeres Fettstoffwechselprofil, höhere Harnsäure- und Glutamat-Pyruvat-Transaminase(GPT)-Werte sowie schlechtere körperliche Fitness und einen höheren Medienkonsum. Es bestand eine signifikante Assoziation von BMI und glomerulärer Filtrationsrate.
Diskussion
Das mit erhöhtem BMI und reduzierter Fitness einhergehende kardiovaskuläre Risiko wird durch weitere Risikofaktoren für die Entwicklung eines metabolischen Syndroms verstärkt. Zusätzlich finden sich Hinweise, dass bereits strukturelle Veränderungen an den Gefäßen vorliegen. Unsere Daten legen eine umfassende Beurteilung des individuellen kardiovaskulären Risikos bei Kindern mit Übergewicht nahe und unterstreichen die Notwendigkeit, Präventionsmaßnahmen früh in den Alltag von Kindern zu implementieren, um die kardiovaskuläre Morbidität im Erwachsenenalter zu verringern.
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van de Velde NM, Roest AAW, van Zwet EW, Niks EH. Increased Blood Pressure and Body Mass Index as Potential Modifiable Factors in The Progression of Myocardial Dysfunction in Duchenne Muscular Dystrophy. J Neuromuscul Dis 2020; 6:65-73. [PMID: 30400104 DOI: 10.3233/jnd-180340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is characterized by progressive cardiomyopathy. Left ventricular (LV) function may worsen by factors increasing LV afterload such as hypertension and obesity. OBJECTIVE To identify potential modifiable risk factors for progression of cardiomyopathy in Duchenne muscular dystrophy (DMD). METHODS We retrospectively analysed systolic blood pressures (SBP) and body-mass indexes (BMI) from 273 visits of 65 DMD patients aged 4-18 years between 2003 and 2016, divided in 14 age groups. Values were normalized using Z-scores (Z-SBP and Z-BMI). A linear mixed model was used to analyse correlations between Z-SBP and BMI, steroid use, age, ambulatory status and cardiac medication (CM) use. To study the relationship between SBP and BMI and myocardial deformation prior to the onset of clinical cardiomyopathy, LV deformation, defined by global longitudinal strain (GLS), was quantified in a subset of 36 patients <11 years. Multiple linear regression was used to study the relation between GLS and clinical parameters. RESULTS Median follow-up was 5 years. SBP was significantly elevated in all age groups under 14 years (p≤0.04) and 15-16 years (p = 0.033) and correlated positively with BMI (p = 0.001) and negatively with CM use over time (p = 0.018). Z-BMI followed a bell-shaped distribution and plotted approximately one standard deviation above the mean in patients between 7 and 15 years. In the subset of younger patients, reduced GLS was associated with higher BMI (β= 0.348, p = 0.004). CONCLUSIONS SBP and BMI may be potentially modifiable factors to retard deterioration of LV function in DMD.
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Affiliation(s)
| | | | | | - Erik Harmen Niks
- Department of Neurology, Leiden University Medical Center, Netherlands
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Kirchhuebel H, Oberhoffer R, Böhm B. Primary Prevention: No Associations of Strength and Cardiorespiratory Fitness Status With Arterial Stiffness in Young School Children. Front Pediatr 2020; 8:175. [PMID: 32457852 PMCID: PMC7221021 DOI: 10.3389/fped.2020.00175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
Pulse wave velocity (PWV) and central systolic blood pressure (CSBP) are well-established biomarkers of arterial stiffness. Further, fitness is known to be an important protective factor in adults in respect of vascular stiffening. However, the association of both muscular and cardiorespiratory fitness (CRF) with arterial properties in younger individuals has been inconsistent. The aim of the present study was to investigate the relationship between anthropometric data, CRF, strength status, and arterial stiffness parameters in German primary school children. A total of 76 children, age 6-11 years (63.2% males) were examined. Peripheral systolic blood pressure (PSBP) [mmHg] and peripheral diastolic blood pressure (PDBP) [mmHg] and PWV [m/s] were measured non-invasively after 10 min of rest with the oscillometric cuff-based Mobil-O-Graph (IEM, Healthcare, Stolberg, Germany). CSBP [mmHg] was calculated using the ARCSolver Algorithm (Austrian Institute of Technology, Vienna, Austria) based on the recorded brachial pulse waves. CRF was measured using the validated Progressive Aerobic Cardiovascular Endurance run (PACER), also called shuttle-run test, for estimating maximal aerobic capacity (VO2max). Hand-grip strength as an indicator of overall muscle strength was determined with the Jamar Analog Hand Dynamometer. The results were recorded in kilograms [kg]. For more detailed analyses, the study group was divided into subcohorts, namely a risk group including children with abnormal blood pressure or high body weight, and a healthy subgroup. Healthy children showed a positive association between PWV and body mass index (BMI) (p = 0.016) and CSBP and BMI (p = 0.033), respectively. Hand-grip strength was positively associated with CSBP (left: p = 0.013, right: p = 0.015) and PWV (left: p = 0.008, right: p = 0.002), as well as the number of shuttle run rounds were positively correlated to PWV (p = 0.038) in the whole cohort. No significant association of converted VO2max with arterial PWV was found. The multivariate regression analysis explained 38.8% (R 2 = 0.388) of the variance and the model was a significant predictor of PWV [F (6, 29) = 3.060, p = 0.019], however, none of the integrated covariates (BMI, number of shuttle run rounds, VO2max, dominant hand-grip strength) contributed significantly to the model. The lack of associations between fitness, strength and arterial stiffness might be explained by the few harmful lifestyle factors influencing vascular changes in the first decade of life.
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Affiliation(s)
- Hannah Kirchhuebel
- Faculty of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Renate Oberhoffer
- Faculty of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Birgit Böhm
- Faculty of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
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Quaresma FRP, da Silva Maciel E, dos Santos Figueiredo FW, Adami F. Factors associated with blood pressure disorders in Afro-descendant children and adolescents. BMC Pediatr 2019; 19:244. [PMID: 31325963 PMCID: PMC6642598 DOI: 10.1186/s12887-019-1626-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hypertension (AH) is an emerging disease that has rapidly increased in the last decades throughout the world. The increase in blood pressure (BP) is observed with growth and development and, although the manifestation of the disease is rare in childhood and adolescence, its occurrence is increasing and the causes are likely to be from different combinations of factors. Afrodescendants have been consistently observed in many populations, including Brazil, which has the largest population of Afrodescendants outside Africa; nevertheless, data is scarce on the disease in children and adolescents. In this study, we investigated BP disorders in children and adolescents of "Quilombola" populations of the state of Tocantins, northern Brazil, and determined the disease occurrence with some factors, namely food consumption, body composition, anthropometric measures, and biochemical data. METHODS We carried out a cross-sectional study with 67 children aged 10-17 years, comparing the variables studied between the normotensive and non-normotensive groups, using the Chi-square test for qualitative variables and the appropriate tests, according to data adherence to the Gaussian distribution for the quantitative variables. High blood pressure was defined as mean systolic or diastolic blood pressure ≥ 90 percentile for age, height, gender. RESULTS The rate of adolescents with BP disorders was 19.4% (prehypertension 14.9% and hypertension 4.5%). There were no significant differences between the sexes for high blood pressure. In the Poisson regression analysis, the high fat percentage was associated with elevated blood pressure (p = 0.021) for adolescents. Similar associations were observed for non-HDL-c (p < 0.001) and low calcium intake (p = 0.015). CONCLUSION Most children and adolescents in "Quilombola" communities had normal blood pressure. However, higher levels of dyslipidemia and low calcium intake are factors associated with prehypertension in the population studied with high BP.
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Affiliation(s)
- Fernando Rodrigues Peixoto Quaresma
- Laboratory of Epidemiology and Data Analysis, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Santo André, São Paulo Brazil
- Federal University of Tocantins, Campus Palmas, Quadra 109 Norte, Avenida NS15, ALCNO-14 - Plano Diretor Norte, Palmas, TO Brazil
| | - Erika da Silva Maciel
- Laboratory of Epidemiology and Data Analysis, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Santo André, São Paulo Brazil
- Federal University of Tocantins, Miracema Campus, Av. Lourdes Solino, 195 - St. Sussuapara, Miracema do Tocantins, TO Brazil
| | | | - Fernando Adami
- Laboratory of Epidemiology and Data Analysis, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Santo André, São Paulo Brazil
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Predictors and Consequences of Pediatric Hypertension: Have Advanced Echocardiography and Vascular Testing Arrived? Curr Hypertens Rep 2019; 21:54. [PMID: 31134437 DOI: 10.1007/s11906-019-0958-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Pediatric hypertension is relatively common and associated with future adult hypertension. Elevated blood pressure in youth predicts future adult cardiovascular disease and blood pressure control can prevent progression of pediatric kidney disease. However, pediatric blood pressure is highly variable within a given child and among children in a population. RECENT FINDINGS Therefore, modalities to index aggregate and cumulative blood pressure status are of potential benefit in identifying youth in danger of progression from a risk factor of subclinical phenotypic alteration to clinically apparent event. In this review, we advocate for the health risk stratification roles of echocardiographically assessed cardiac remodeling, arterial stiffness assessment, and assessment by ultrasound of arterial thickening in children and adolescents with hypertension.
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Hui W, Slorach C, Guerra V, Parekh RS, Hamilton J, Messiha S, Tse E, Mertens L, Narang I. Effect of Obstructive Sleep Apnea on Cardiovascular Function in Obese Youth. Am J Cardiol 2019; 123:341-347. [PMID: 30420185 DOI: 10.1016/j.amjcard.2018.09.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
The increasing prevalence of overweight or obese children and adolescents is a significant global health concern. Although the effect of obesity on cardiovascular function has been investigated, little is known on the impact of associated obstructive sleep apnea (OSA) in obese youth. The aim of the present study was to investigate the influence of OSA on cardiovascular functional parameters in obese youth. This is a prospective single-center observational cross-sectional study. Forty-four obese patients and 44 age- and gender-matched control subjects were included. All patients underwent polysomnography and cardiovascular assessment including functional echocardiography and carotid-femoral pulse wave velocity (PWV). Obese patients had higher left ventricular (LV) mass/height2.7, preserved LV systolic parameters, differences in LV diastolic parameters, and increased PWV and systolic blood pressure at rest compared with control group. In obese youth, 14 of 44 (32%) had OSA. There was no correlation between obesity and the apnea-hypopnea index (AHI). LV mass/height2.7 significantly correlated with body mass index z-score (r = 0.648, p <0.001) whereas PWV correlated with AHI (r = 0.352, p = 0.038). In obese patients, body mass index z-score was an independent predictor for LV mass/height2.7 (r = 0.61, p <0.001) and AHI was an independent predictor for higher PWV (r = 0.352, p = 0.038). In conclusion, both obesity and OSA influence cardiovascular performance in obese youth. Although obesity is associated with increased LV mass and reduced LV diastolic function, OSA is associated with changes in arterial stiffness.
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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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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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Fujiwara H, Nakajima H, Inoue F, Kosaka K, Asano H, Yoshii K. Arterial stiffness in junior high school students: Longitudinal observations. Pediatr Int 2018; 60:127-135. [PMID: 29230906 DOI: 10.1111/ped.13475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/15/2017] [Accepted: 11/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early atherosclerotic change is found even in childhood, and there is an urgent need to clarify the factors causing childhood atherosclerosis and take preventive measures. Early detection of the contributing risk factors is crucial to facilitate preventive measures. Pulse wave velocity (PWV) is a widely used technique for the assessment of atherosclerosis in children. METHODS Lifestyle questionnaire, brachio-ankle PWV (baPWV) and anthropometric data were obtained from junior high school students in an urban area of Japan between 2006 and 2008, from seventh to ninth grades. RESULTS Mean baPWV increased from 867.4 ± 99.5 m/s to 944.5 ± 117.5 m/s in boys, and from 864.0 ± 99.5 m/s to 923.0 ± 101.3 m/s in girls. Obese students had higher baPWV than non-obese students in both genders across each grade. On logistic regression analysis of ninth grade student data, high baPWV was dependent on systolic blood pressure (SBP), time watching television (TV) and symptoms of depression and anxiety, whereas low baPWV was dependent on time playing video games, light exercise, sleep and indoor play, as well as good friendship and motivation. CONCLUSION Systolic blood pressure, time watching TV, and symptoms of depression and anxiety may contribute to arterial stiffness and be related to obesity in junior high school students.
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Affiliation(s)
- Hiroshi Fujiwara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, Japan
| | - Hisakazu Nakajima
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, Japan
| | - Fumio Inoue
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, Japan.,Department of Education, Kyoto University of Education, Fukakusa, Fushimi, Kyoto, Japan
| | - Kitaro Kosaka
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, Japan
| | - Hiroaki Asano
- School of Nursing, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Hirokoji-Kawaramachi, Kamigyo, Japan
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Hudson L, Kinra S, Wong I, Cole TJ, Deanfield J, Viner R. Is arterial stiffening associated with adiposity, severity of obesity and other contemporary cardiometabolic markers in a community sample of adolescents with obesity in the UK? BMJ Paediatr Open 2017; 1:e000061. [PMID: 29637110 PMCID: PMC5862218 DOI: 10.1136/bmjpo-2017-000061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) prediction is problematic within groups of obese adolescents as measures such as adiposity and metabolic markers lack validation. Pulse wave velocity (PWV), a proxy for arterial stiffening, is a potential way to contemporaneously capture adolescents at greater risk of CVD. OBJECTIVES To investigate associations between PWV and 1) adiposity and 2) other conventional metabolic factors in a community sample of (>95th centile body mass index (BMI)). DESIGN AND SETTING Cross-sectional measurement and analysis in a hospital-based research centre drawn from a community sample of adolescents recruited to an obesity intervention at baseline. PATIENTS 174 adolescents (12-19 years) with obesity (>95th centile BMI). 37% were male, while 66 (38%) were white, 53 (30%) black, 36 (21%) South Asian, 19 (11%) mixed/other. Participants with endocrine, genetic causes of obesity and chronic medical conditions (excluding asthma) were excluded. MEASURES BMI z-score (zBMI), waist z-score, fat mass index (FMI: measured using bioimpedance), sagittal abdominal dimension (SAD), cardiometabolic blood tests and resting blood pressure (BP) were collected. Carotid-radial PWV was measured by a single operator. RESULTS PWV was associated with age but not pubertal stage. PWV was positively associated with adiposity (zBMI: coefficient 0.44 (95% CI 0.08 to 0.79); FMI: coefficient 0.05 (95% CI 0.00 to 0.10); waist z-score: coefficient 0.27 (95% CI 0.00 to 0.53); SAD: coefficient 0.06 (95% CI: 0.00 to 0.12)). There was no association between PWV and BP, and few associations with cardiometabolic bloods. Associations between PWV and adiposity measures were robust to adjustment in multivariable models except for SAD. Participants with zBMI >2.5 SD and >3.5 SD had greater average PWV but overlap between groups was large. CONCLUSIONS In our sample, increasing adiposity was positively associated with arterial stiffness, however partitioning by severity was not reliable. Lack of associations between BP, cardiometabolic bloods and arterial stiffness questions the reliability of these factors for predicting CVD risk in adolescents with obesity.
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Affiliation(s)
- Lee Hudson
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Wong
- UCL School of Pharmacy, London, UK
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - John Deanfield
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell Viner
- UCL Great Ormond Street Institute of Child Health, London, UK
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Defining and Diagnosing Elevated Blood Pressure in Children and Adolescents. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0519-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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