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Ananthamohan K, Brady TM, Arif M, Daniels S, Falkner B, Ferguson M, Flynn JT, Hanevold C, Hooper SR, Ingelfinger J, Lande M, Martin LJ, Meyers KE, Mitsnefes M, Rosner B, Samuels JA, Kuffel G, Zilliox MJ, Becker RC, Urbina EM, Sadayappan S. A Multi-Omics Approach to Defining Target Organ Injury in Youth with Primary Hypertension. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.17.599125. [PMID: 38948714 PMCID: PMC11212900 DOI: 10.1101/2024.06.17.599125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Primary hypertension in childhood tracks into adulthood and may be associated with increased cardiovascular risk. Studies conducted in children and adolescents provide an opportunity to explore the early cardiovascular target organ injury (CV-TOI) in a population free from many of the comorbid cardiovascular disease risk factors that confound studies in adults. METHODS Youths (n=132, mean age 15.8 years) were stratified by blood pressure (BP) as low, elevated, and high-BP and by left ventricular mass index (LVMI) as low- and high-LVMI. Systemic circulating RNA, miRNA, and methylation profiles in peripheral blood mononuclear cells and deep proteome profiles in serum were determined using high-throughput sequencing techniques. RESULTS VASH1 gene expression was elevated in youths with high-BP with and without high-LVMI. VASH1 expression levels positively correlated with systolic BP (r=0.3143, p=0.0034). The expression of hsa-miR-335-5p, one of the VASH1-predicted miRNAs, was downregulated in high-BP with high-LVMI youths and was inversely correlated with systolic BP (r=-0.1891, p=0.0489). GSE1 hypermethylation, circulating PROZ upregulation (log2FC=0.61, p=0.0049 and log2FC=0.62, p=0.0064), and SOD3 downregulation (log2FC=-0.70, p=0.0042 and log2FC=-0.64, p=0.010) were observed in youths with elevated BP and high-BP with high-LVMI. Comparing the transcriptomic and proteomic profiles revealed elevated HYAL1 levels in youths displaying high-BP and high-LVMI. CONCLUSIONS The findings are compatible with a novel blood pressure-associated mechanism that may occur through impaired angiogenesis and extracellular matrix degradation through dysregulation of Vasohibin-1 and Hyaluronidase1 was identified as a possible mediator of CV-TOI in youth with high-BP and suggests strategies for ameliorating TOI in adult-onset primary hypertension.
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Affiliation(s)
- Kalyani Ananthamohan
- Department of Internal Medicine, Division of Cardiovascular Health and Diseases, Center for Cardiovascular Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tammy M. Brady
- Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD
| | - Mohammed Arif
- Department of Internal Medicine, Division of Cardiovascular Health and Diseases, Center for Cardiovascular Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stephen Daniels
- Department of Pediatrics, Denver Children’s Hospital, Aurora, CO
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA
| | | | - Joseph T. Flynn
- Department of Pediatrics, University of Washington School of Medicine, Division of Nephrology, Seattle Children’s Hospital, Seattle, WA
| | - Coral Hanevold
- Department of Pediatrics, University of Washington School of Medicine, Division of Nephrology, Seattle Children’s Hospital, Seattle, WA
| | - Stephen R. Hooper
- School of Medicine, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Julie Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children at Massachusetts General Brigham, Boston, MA
| | - Marc Lande
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Lisa J. Martin
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kevin E. Meyers
- Division of Nephrology and Hypertension, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bernard Rosner
- Channing Division of Network Medicine, Harvard University, Cambridge, MA
| | - Joshua A. Samuels
- Pediatric Nephrology & Hypertension, McGovern Medical School, University of Texas, Houston, TX
| | - Gina Kuffel
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL
| | - Michael J. Zilliox
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL
| | - Richard C. Becker
- Department of Internal Medicine, Division of Cardiovascular Health and Diseases, Center for Cardiovascular Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elaine M. Urbina
- Division of Cardiology, Heart Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Division of Cardiovascular Health and Diseases, Center for Cardiovascular Research, University of Cincinnati College of Medicine, Cincinnati, OH
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Hamdani G, Urbina EM, Daniels SR, Falkner BE, Ferguson MA, Flynn JT, Hanevold CD, Ingelfinger JR, Khoury PR, Lande MB, Meyers KE, Samuels J, Mitsnefes M. Ambulatory Blood Pressure and Number of Subclinical Target Organ Injury Markers in Youth: The SHIP AHOY Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.15.24304137. [PMID: 38562855 PMCID: PMC10984045 DOI: 10.1101/2024.03.15.24304137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents. Methods 244 participants (mean age 15.5±1.8 years, 60.1% male) were studied. Participants were divided based on both systolic clinic and ambulatory BP (ABP), into low- (<75 th percentile), mid- (75 th -90 th percentile) and high-risk (>90 th percentile) groups. TOI assessments included left ventricular mass, systolic and diastolic function, and vascular stiffness. The number of TOI markers for each participant was calculated. A multivariable general linear model was constructed to evaluate the association of different participant characteristics with higher numbers of TOI markers. Results 47.5% of participants had at least one TOI marker: 31.2% had one, 11.9% two, 3.7% three, and 0.8% four. The number of TOI markers increased according to the BP risk groups: the percentage of participants with more than one TOI in the low-, mid-, and high groups based on clinic BP was 6.7%, 19.1%, and 21.8% (p=0.02), and based on ABP was 9.6%, 15.8%, and 32.2% (p<0.001). In a multivariable regression analysis, both clinic BP percentile and ambulatory SBP index were independently associated with the number of TOI markers. When both clinic and ABP were included in the model, only the ambulatory SBP index was significantly associated with the number of markers. Conclusion High SBP, especially when assessed by ABPM, was associated with an increasing number of subclinical cardiovascular injury markers in adolescents.
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Urbina EM, Daniels SR, Sinaiko AR. Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here? Hypertension 2023; 80:1572-1579. [PMID: 37278234 PMCID: PMC10524445 DOI: 10.1161/hypertensionaha.122.19455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The association between hypertension in adulthood and cardiovascular morbidity and death is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.
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Affiliation(s)
- Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati
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Halbach SM, Flynn JT. Childhood Primary Hypertension: Not Uncommon, Not Benign. Hypertension 2023; 80:1197-1198. [PMID: 37196099 DOI: 10.1161/hypertensionaha.123.21041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Susan M Halbach
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, and Division of Nephrology, Seattle Children's Hospital, Seattle, WA (S.M.H., J.T.F.)
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, and Division of Nephrology, Seattle Children's Hospital, Seattle, WA (S.M.H., J.T.F.)
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Binka E, Urbina EM, Manlhiot C, Alsaied T, Brady TM. Association of Childhood Blood Pressure with Left Atrial Size and Function: Study of High Blood Pressure in Pediatrics-Adult Hypertension in Youth (SHIP AHOY). J Pediatr 2023; 255:190-197.e1. [PMID: 36470463 PMCID: PMC10121756 DOI: 10.1016/j.jpeds.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE(S) To evaluate the cross-sectional association of cardiovascular disease risk factors with left atrial (LA) size and function among healthy youth, aged 11-18 years, with a wide range of blood pressures (BPs). STUDY DESIGN Echocardiographic images of youth enrolled in the Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth study were analyzed for LA measurements. The association of casual BP, ambulatory BP, and other cardiovascular disease risk factors with LA size and function were determined using descriptive statistics and multivariable regression. Regression models adjusting for age, sex, race, and body mass index z score determined the independent association between ambulatory systolic BP indices (mean systolic BP/50th %ile systolic BP) and BP phenotypes with LA outcomes while exploratory analyses investigated for additional predictors of LA outcomes. RESULTS The study population consisted of 347 youth: median age 15.7 years, 60% male and 40% non-White. Greater-risk casual systolic BP groups had worse cardiometabolic profiles but no differences in LA size and function. Each 0.1 increase in ambulatory systolic BP day or night index was associated with a 9.9 mL/m2 increase in LA volume/body surface area (LAV/BSA; 95th% CI 2.8-17.0, P = .006) and a 6.8 mL/m2 increase in LAV/BSA (95th% CI 0.8-12.8, P = .03), respectively. Ambulatory hypertension was associated with greater odds of abnormal LAV/BSA, defined as >75th %ile (2014 ambulatory BP monitoring criteria: OR 3.2 [95th% CI 1.4-7.2; P = .002]; 2022 ambulatory BP monitoring criteria: OR 2.1 [95th% CI 1.0-4.1; P = .008]). CONCLUSIONS Increasing ambulatory systolic BP and ambulatory hypertension are independently associated with LAV/BSA.
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Affiliation(s)
- Edem Binka
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT.
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cedric Manlhiot
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tarek Alsaied
- The Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Basalely A, Hill-Horowitz T, Sethna CB. Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes. Curr Hypertens Rep 2023; 25:1-11. [PMID: 36434426 DOI: 10.1007/s11906-022-01231-3] [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: 11/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights the major changes reflected in the 2022 American Heart Association (AHA) Scientific Statement on Ambulatory Blood Pressure Monitoring (ABPM) in Children and Adolescents with a specific focus on the newly defined phenotypes of hypertension and their epidemiology and associated outcomes. RECENT FINDINGS The 2022 AHA guidelines' most notable changes include the following: (1) alignment of blood pressure (BP) thresholds with the 2017 American Academy of Pediatrics (AAP) clinical practice guidelines, 2017 American College of Cardiology (ACC)/AHA hypertension guidelines, and 2016 European Society of Hypertension (ESH) pediatric recommendations; (2) expansion of the use of ABPM to diagnose and phenotype pediatric hypertension in all pediatric patients; (3) removal of BP loads from diagnostic criteria; and (4) simplified classification of new hypertension phenotypes to prognosticate risks and guide clinical management. Recent studies suggest that utilizing the 2022 AHA pediatric ABPM guidelines will increase the prevalence of pediatric ambulatory hypertension, especially for wake ambulatory hypertension in older, taller males and for nocturnal hypertension in both males and females ≥ 8 years of age. The new definitions simplify the ambulatory hypertension criteria to include only the elements most predictive of future health outcomes, increase the sensitivity of BP thresholds in alignment with recent data and other guidelines, and thus make hypertension diagnoses more clinically meaningful. This guideline will also aid in the transition of adolescents and young adults to adult medical care. Further studies will be necessary to study ambulatory BP norms in a more diverse pediatric population and evaluate the impact of these guidelines on prevalence and future outcomes.
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Affiliation(s)
- Abby Basalely
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Taylor Hill-Horowitz
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA
| | - Christine B Sethna
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA. .,Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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Butler JE, Vincent C, South AM, Chanchlani R. Updates to Pediatric Ambulatory Blood Pressure Monitoring in Clinical Practice: a Review and Strategies for Expanding Access. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00273-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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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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9
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Price JJ, Urbina EM, Carlin K, Becker R, Daniels SR, Falkner BE, Ferguson M, Hanevold C, Hooper SR, Ingelfinger JR, Lande MB, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels J, Flynn JT. Cardiovascular Risk Factors and Target Organ Damage in Adolescents: The SHIP AHOY Study. Pediatrics 2022; 149:186966. [PMID: 35502610 PMCID: PMC9648121 DOI: 10.1542/peds.2021-054201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Development of cardiovascular disease in adults has been directly linked to an adverse metabolic phenotype. While there is evidence that development of these risk factors in childhood persists into adulthood and the development of cardiovascular disease, less is known about whether these risk factors are associated with target organ damage during adolescence. METHODS We collected data from 379 adolescents (mean age 15.5, 60% male) with blood pressure between the 75th and 95th percentile to determine if there is a metabolic phenotype that predicts cardiovascular changes (left ventricular mass, systolic and diastolic function, pulse wave velocity, and renal function). We determined the number of risk factors for cardiovascular disease (hypertension, dyslipidemia, obesity, and insulin resistance) present in each participant. Generalized linear models were constructed to determine if the number of cardiovascular risk factors (CVRFs) were associated with measures of target organ damage. RESULTS The number of CVRFs present were associated with statistically significant differences in increased left ventricular mass index, increased pulse wave velocity, decreased peak longitudinal strain, urine albumin to creatine ratio and echocardiographic parameters of diastolic dysfunction. Generalized linear models showed that dyslipidemia and insulin resistance were independently associated with markers of diastolic dysfunction (P ≤ .05) while increased blood pressure was associated with all makers of target organ damage (P ≤ .03). CONCLUSIONS These data suggest the of the number of CVRFs present is independently associated with early changes in markers of target organ damage during adolescence.
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Affiliation(s)
| | | | | | | | | | - Bonita E Falkner
- Departments of Pediatrics and Medicine, Thomas Jefferson
University, Philadelphia, Pennsylvania
| | | | | | - Stephen R Hooper
- School of Medicine, University of North Carolina, Chapel
Hill, North Carolina
| | | | - Marc B. Lande
- Department of Pediatrics, University of Rochester Medical
Center, Rochester, New York
| | | | - Kevin Meyers
- Childrens Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Bernard Rosner
- Department of MedicineHarvard University, Boston,
Massachusetts
| | - Joshua Samuels
- University of Texas Health Sciences Center, Houston,
Texas
| | - Joseph T. Flynn
- Seattle Children’s Hospital, Seattle,
Washington,Address correspondence to Joseph T. Flynn, MD, 4800 Sandpoint Way
NE Seattle, WA 98105. E-mail:
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10
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Kim JY, Cho H, Kim JH. Difference in the Prevalence of Elevated Blood Pressure and Hypertension by References in Korean Children and Adolescents. Front Med (Lausanne) 2022; 9:793771. [PMID: 35280904 PMCID: PMC8907724 DOI: 10.3389/fmed.2022.793771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
The prevalence of pediatric hypertension and obesity has increased over the past decades. Pediatric hypertension and obesity are associated with adult hypertension, metabolic syndrome, and cardiovascular disease. There are two main pediatric blood pressure (BP) classification guidelines, the "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents" (AAP 2017) and "2016 European Society of Hypertension guidelines for the management of high BP in children and adolescents" (ESH 2016). No study has classified Korean youths with cardiometabolic risk. This study analyzed the prevalence of high BP according to AAP 2017 (elevated BP and hypertension) and ESH 2016 (prehypertension and hypertension) in Korean children. Additionally, the cardiometabolic risk factors (CMRFs) were compared between children who were hypertensive in AAP 2017 but normotensive in ESH 2016 (upward reclassified) to those who were normotensive in both AAP 2017 and ESH 2016. Data were extracted from the Korea National Health and Nutrition Examination Survey, 2016-2018. A total of 1,858 children aged 10-17 years were included in the analysis. The prevalence of elevated BP/prehypertension and hypertension was 4.1 and 6.5% by ESH 2016, and 8.9 and 9.4% by AAP 2017 in Korean youth, respectively. The AAP 2017 reclassified 11.9% of youth in the upper BP class. When those upward reclassified youth were compared to those who were normotensive in both AAP 2017 and ESH 2016, reclassified youth were male predominant (77.1 vs. 49.6%, p < 0.001), older (14.6 vs. 13.8, p < 0.001) and showed higher body mass index (BMI) z-score (0.77 vs. 0.15, p < 0.001) and more overweight/obesity (14.0/30.6 vs. 13.3/6.4%, p < 0.001) and severe CMRFs (triglyceride 83.2 vs. 72.9 mg/dL, p = 0.011; high-density lipoprotein cholesterol 47.3 vs. 51.1 mg/dL, p < 0.001; alanine transaminase 21.7 IU/L vs. 14.7 IU/L, p = 0.001, uric acid 5.89 vs. 5.22 mg/dL, p < 0.001; metabolic syndrome 13.2 vs. 1%, p < 0.001). In conclusion, AAP 2017 showed a higher prevalence of abnormal BP in Korean youth, and those upward reclassified by AAP 2017 were more obese and had severe CMRFs than normotensive Korean children. The AAP 2017 could allow the early detection of Korean youth with more CMRFs.
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Affiliation(s)
- Jeong Yeon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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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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12
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High blood pressure in children and adolescents: current perspectives and strategies to improve future kidney and cardiovascular health. Kidney Int Rep 2022; 7:954-970. [PMID: 35570999 PMCID: PMC9091586 DOI: 10.1016/j.ekir.2022.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Hypertension is one of the most common causes of preventable death worldwide. The prevalence of pediatric hypertension has increased significantly in recent decades. The cause of this is likely multifactorial, related to increasing childhood obesity, high dietary sodium intake, sedentary lifestyles, perinatal factors, familial aggregation, socioeconomic factors, and ethnic blood pressure (BP) differences. Pediatric hypertension represents a major public health threat. Uncontrolled pediatric hypertension is associated with subclinical cardiovascular disease and adult-onset hypertension. In children with chronic kidney disease (CKD), hypertension is also a strong risk factor for progression to kidney failure. Despite these risks, current rates of pediatric BP screening, hypertension detection, treatment, and control remain suboptimal. Contributing to these shortcomings are the challenges of accurately measuring pediatric BP, limited access to validated pediatric equipment and hypertension specialists, complex interpretation of pediatric BP measurements, problematic normative BP data, and conflicting society guidelines for pediatric hypertension. To date, limited pediatric hypertension research has been conducted to help address these challenges. However, there are several promising signs in the field of pediatric hypertension. There is greater attention being drawn on the cardiovascular risks of pediatric hypertension, more emphasis on the need for childhood BP screening and management, new public health initiatives being implemented, and increasing research interest and funding. This article summarizes what is currently known about pediatric hypertension, the existing knowledge-practice gaps, and ongoing research aimed at improving future kidney and cardiovascular health.
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13
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Brady TM. The More Things Change, the More Things Stay the Same? J Pediatr 2022; 241:10-11.e1. [PMID: 34762899 DOI: 10.1016/j.jpeds.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Tammy M Brady
- Department of Pediatrics, Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD
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14
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Dawson AE, Kallash M, Spencer JD, Wilson CS. The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care. Pediatr Nephrol 2021; 36:3869-3883. [PMID: 33890179 DOI: 10.1007/s00467-021-05077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.
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Affiliation(s)
- Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Mahmoud Kallash
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - John D Spencer
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA
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15
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Pollack AH, Hanevold C, Onchiri F, Flynn JT. Influence of Blood Pressure Percentile Reporting on the Recognition of Elevated Blood Pressures. Hosp Pediatr 2021; 11:799-807. [PMID: 34215652 DOI: 10.1542/hpeds.2020-002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the impact of displaying blood pressure (BP) percentiles with BP readings in the electronic health record (EHR) on the recognition of children with elevated blood pressures (EBPs). METHODS This was a retrospective cohort study of children (ages 1-17), including inpatients and outpatients, with at least 1 EHR noninvasive BP recording. In phase 1, BP percentiles were calculated, stored, and not displayed to clinicians. In phase 2, percentiles were displayed adjacent to the EHR BP. Encounters with 1 BP ≥95th percentile were classified as elevated. EBP recognition required the presence of at least 1 EBP-related International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision code. We compared recognition frequencies across phases with logistic regression. RESULTS In total, 45 504 patients in 115 060 encounters were included. Inpatient recognition was 4.1% (238 of 5572) in phase 1 and 5.5% (338 of 5839) in phase 2. The adjusted odds ratio (OR) associated with the intervention was 1.22 (95% confidence interval [CI]: 0.90-1.66). Outpatient recognition rates were 8.0% (1096 of 13 725 EBP encounters) in phase 1 and 9.7% (1442 of 14 811 encounters) in phase 2. The adjusted OR was 1.296 (95% CI: 0.999-1.681). Overall, recognition rates were higher in boys (outpatient OR: 1.51; 95% CI: 1.15-1.98) and older children (outpatient/inpatient OR: 1.08/1.08; 95% CI: 1.05-1.11/1.05-1.11) and lower for those on a surgical service (outpatient/inpatient: OR: 0.41/0.38; 95% CI: 0.30-0.58/0.27-0.52). CONCLUSIONS Addition of BP percentiles to the EHR did not significantly change EBP recognition as measured by the addition of an EBP diagnosis code. Girls, younger children, and patients followed on a surgical service were less likely to have their EBP recognized by providers.
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Affiliation(s)
- Ari H Pollack
- Division of Nephrology .,Seattle Children's Hospital, Seattle, Washington
| | - Coral Hanevold
- Division of Nephrology.,Seattle Children's Hospital, Seattle, Washington
| | | | - Joseph T Flynn
- Division of Nephrology.,Seattle Children's Hospital, Seattle, Washington
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16
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Brady TM, Altemose K, Urbina EM. Impact of the 2017 American Academy of Pediatrics' Clinical Practice Guideline on the Identification and Risk Stratification of Youth at Increased Cardiovascular Disease Risk. Hypertension 2021; 77:1815-1824. [PMID: 33813845 PMCID: PMC8119317 DOI: 10.1161/hypertensionaha.121.14585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The updated clinical practice guideline (CPG) published by the American Academy of Pediatrics in 2017 introduced significant changes to the diagnostic and evaluative approach towards children with elevated blood pressure. The goals of this review were to summarize the current evidence regarding the impact of the new CPG on the identification and risk stratification of children at increased cardiovascular disease risk. Universally, the new CPG definitions of abnormal blood pressure led to more children classified as having a hypertensive blood pressure when compared with alternative definitions. Youth who moved to a higher blood pressure stage with the CPG typically had worse cardiometabolic profiles and more comorbidites. The association of CPG-defined hypertension and concurrent intermediate cardiovascular disease outcomes such as left ventricular hypertrophy and increased pulse wave velocity remains unclear; however, longitudinal data suggests an improved identification of those at greatest risk for adult cardiovascular disease with the CPG definitions. The majority of studies reviewed used blood pressure from one encounter, not replicate blood pressures from multiple visits, to define an abnormal or hypertensive blood pressure. Therefore, future studies investigating the prevalence of confirmed hypertension and the association between confirmed hypertension and outcomes are needed to optimally characterize the performance of the new CPG on identifying children at cardiovascular disease risk.
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Affiliation(s)
- Tammy M. Brady
- Johns Hopkins University School of Medicine, Division of Pediatric Nephrology
| | - Kathleen Altemose
- Penn State College of Medicine, Division of Pediatric Nephrology and Hypertension
| | - Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center, Division of Cardiology
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17
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Hamdani G, Mitsnefes MM, Flynn JT, Becker RC, Daniels S, Falkner BE, Ferguson M, Hooper SR, Hanevold CD, Ingelfinger JR, Lande M, Martin LJ, Meyers KE, Rosner B, Samuels J, Urbina EM. Pediatric and Adult Ambulatory Blood Pressure Thresholds and Blood Pressure Load as Predictors of Left Ventricular Hypertrophy in Adolescents. Hypertension 2021; 78:30-37. [PMID: 33966453 DOI: 10.1161/hypertensionaha.120.16896] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Gilad Hamdani
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
| | - Mark M Mitsnefes
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
| | - Joseph T Flynn
- Seattle Children's Hospital, Seattle, WA (J.T.F., C.D.H.)
| | | | | | | | | | | | | | | | - Marc Lande
- University of Rochester Medical Center, Rochester, NY (M.L.)
| | - Lisa J Martin
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
| | | | | | - Joshua Samuels
- University of Texas Health Sciences Center, Houston (J.S.)
| | - Elaine M Urbina
- Schneider Children's Medical Center, Petach Tikvah, Israel (G.H.)
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18
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Santillan MK, Becker RC, Calhoun DA, Cowley AW, Flynn JT, Grobe JL, Kotchen TA, Lackland DT, Leslie KK, Liang M, Mattson DL, Meyers KE, Mitsnefes MM, Muntner PM, Pierce GL, Pollock JS, Sigmund CD, Thomas SJ, Urbina EM, Kidambi S. Team Science: American Heart Association's Hypertension Strategically Focused Research Network Experience. Hypertension 2021; 77:1857-1866. [PMID: 33934625 DOI: 10.1161/hypertensionaha.120.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2015, the American Heart Association awarded 4-year funding for a Strategically Focused Research Network focused on hypertension composed of 4 Centers: Cincinnati Children's Hospital, Medical College of Wisconsin, University of Alabama at Birmingham, and University of Iowa. Each center proposed 3 integrated (basic, clinical, and population science) projects around a single area of focus relevant to hypertension. Along with scientific progress, the American Heart Association put a significant emphasis on training of next-generation hypertension researchers by sponsoring 3 postdoctoral fellows per center over 4 years. With the center projects being spread across the continuum of basic, clinical, and population sciences, postdoctoral fellows were expected to garner experience in various types of research methodologies. The American Heart Association also provided a number of leadership development opportunities for fellows and investigators in these centers. In addition, collaboration was highly encouraged among the centers (both within and outside the network) with the American Heart Association providing multiple opportunities for meeting and expanding associations. The area of focus for the Cincinnati Children's Hospital Center was hypertension and target organ damage in children utilizing ambulatory blood pressure measurements. The Medical College of Wisconsin Center focused on epigenetic modifications and their role in pathogenesis of hypertension using human and animal studies. The University of Alabama at Birmingham Center's areas of research were diurnal blood pressure patterns and clock genes. The University of Iowa Center evaluated copeptin as a possible early biomarker for preeclampsia and vascular endothelial function during pregnancy. In this review, challenges faced and successes achieved by the investigators of each of the centers are presented.
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Affiliation(s)
- Mark K Santillan
- Obstetrics/Gynecology (M.K.S.,K.K.L), University of Iowa, Iowa City, IA
| | - Richard C Becker
- Internal Medicine (R.C.B.), Cincinnati Children's Hospital, Cincinnati, OH
| | - David A Calhoun
- Internal Medicine (D.A.C., J.S.P.), University of Alabama at Birmingham, AL
| | - Allen W Cowley
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | | | - Justin L Grobe
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | - Theodore A Kotchen
- Internal Medicine (T.A.K., S.K.), Medical College of Wisconsin, Milwaukee, WI
| | - Daniel T Lackland
- Neurology, Medical University of South Carolina, Charleston, SC (D.T.L.)
| | - Kimberly K Leslie
- Obstetrics/Gynecology (M.K.S.,K.K.L), University of Iowa, Iowa City, IA
| | - Mingyu Liang
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | - David L Mattson
- Physiology, Medical College of Georgia, Augusta, GA (D.L.M.)
| | - Kevin E Meyers
- Pediatrics, Children's Hospital of Philadelphia, PA (K.E.M.)
| | - Mark M Mitsnefes
- Pediatrics (M.M.M., E.M.U), Cincinnati Children's Hospital, Cincinnati, OH
| | - Paul M Muntner
- Epidemiology (P.M.M.), University of Alabama at Birmingham, AL
| | - Gary L Pierce
- Health and Human Physiology (G.L.P), University of Iowa, Iowa City, IA
| | - Jennifer S Pollock
- Internal Medicine (D.A.C., J.S.P.), University of Alabama at Birmingham, AL
| | - Curt D Sigmund
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | | | - Elaine M Urbina
- Pediatrics (M.M.M., E.M.U), Cincinnati Children's Hospital, Cincinnati, OH
| | - Srividya Kidambi
- Internal Medicine (T.A.K., S.K.), Medical College of Wisconsin, Milwaukee, WI
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19
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Kruger R, Gafane-Matemane LF, Kagura J. Racial differences of early vascular aging in children and adolescents. Pediatr Nephrol 2021; 36:1087-1108. [PMID: 32444927 DOI: 10.1007/s00467-020-04593-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
The prevalence of non-communicable disease (NCDs) is rising globally, with a large burden recorded in sub-Saharan countries and populations of black race/ethnicity. Accelerated vascular deterioration, otherwise known as early vascular aging (EVA), is the underlying factor for highly prevalent NCDs such as hypertension. The etiology of EVA is multifactorial with a central component being arterial stiffness with subsequent development of hypertension and cardiovascular complications. Although arterial stiffness develops with increasing age, many children and adolescents are subjected to the premature development of arterial stiffness, due to genetic or epigenetic predispositions, lifestyle and behavioral risk factors, and early life programming. Race/ethnic differences in pediatric populations have also been reported with higher aortic stiffness in black (African American) compared with age-matched white (European American) counterparts independent of blood pressure, body mass index, or socioeconomic status. With known evidence of race/ethnic differences in EVA, the pathophysiological mechanisms underlying graded differences in the programming of EVA are still sparse and rarely explored. This educational review aims to address the early life determinants of EVA in children and adolescents with a particular focus on racial or ethnic differences.
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Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Lebo Francina Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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20
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Hong D, Shan W. Improvement in Hypertension Management with Pharmacological and Non- Pharmacological Approaches: Current Perspectives. Curr Pharm Des 2021; 27:548-555. [PMID: 32962608 DOI: 10.2174/1381612826666200922153045] [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: 03/15/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Improving hypertension management is still one of the biggest challenges in public health worldwide. Existing guidelines do not reach a consensus on the optimal Blood Pressure (BP) target. Therefore, how to effectively manage hypertension based on individual characteristics of patients, combined with the pharmacological and non-pharmacological approach, has become a problem to be urgently considered. METHODS Reports published in PubMed that covered Pharmacological and Non-Pharmacological Approaches in subjects taking hypertension management were reviewed by the group independently and collectively. Practical recommendations for hypertension management were established by the panel. RESULTS Pharmacological mechanism, action characteristics, and main adverse reactions varied across different pharmacological agents, and patients with hypertension often require a combination of antihypertensive medications to achieve the target BP range. Non-pharmacological treatment provides an additional effective method for improving therapy adherence and long-term BP control, thus reducing the risk of cardiovascular diseases, and slowing down the progression of the disease. CONCLUSION This review summarizes the available literature on the most convincing guideline principles, pharmacological treatment, biotechnology interference, interventional surgical treatment, managing hypertension with technical means of big data, Artificial Intelligence and Behavioral Intervention, as well as providing future directions, for facilitating Current and Developing knowledge into clinical implementation.
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Affiliation(s)
- Dongsheng Hong
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wenya Shan
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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21
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Martinis O, Čoklo M, Aladrović J, Belavić A, Missoni S. ANTHROPOMETRIC MEASUREMENTS, DIETARY HABITS, SERUM LIPID AND GLUCOSE LEVELS IN RELATION TO HIGH BLOOD PRESSURE AMONG ADOLESCENT BOYS AND GIRLS IN CROATIA. Acta Clin Croat 2020; 59:672-685. [PMID: 34285438 PMCID: PMC8253067 DOI: 10.20471/acc.2020.59.04.14] [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: 03/03/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
The aim was to determine differences in anthropometric measurements, dietary habits, serum lipid and glucose levels in relation to high blood pressure (BP) among adolescent boys and girls in Croatia. The specific aim was to determine the effect of dietary habits and lifestyle on high BP in adolescents according to sex. The study included 260 (68.2%) adolescent girls and 121 (31.8%) boys with anthropometric data obtained (without missing values) from 246 girls and 111 boys. Participants answered questions from the questionnaire and anthropometric BP and blood test values were obtained. Non-parametric tests were used in analyses of reference intervals of systolic and diastolic BP in adolescent boys and girls according to age. High BP was defined as ≥90th percentile for adolescent girls and boys, with a value of ≥135/87.5 mm Hg. Mann-Whitney U test was used to analyze differences in anthropometric and laboratory values between the groups of girls and boys with high (≤90th percentile) and normal BP. Increase in systolic and diastolic BP was noted in the adolescents. In girls, BP values showed a decreasing systolic and increasing diastolic BP trend with age. Girls with high BP had a significantly higher body mass index (BMI) (p=0.020), waist circumference (WC) (p=0.002), waist-to-height ratio (WHtR) (p=0.016), waist-to-hip ratio (WHR) (p=0.043), hip circumference (HC) (p=0.015), triglyceride (TG) levels (p=0.021), higher prevalence of unhealthy diet at school breakfast (p=0.008) and lower prevalence of eating fish (p=0.02). Boys with high BP had a significantly higher BMI (p=0.045), WC (p=0.004), WHtR (p=0.017), WHR (p=0.022) and higher prevalence of eating meat products (p=0.015). Effective health interventions are needed to reduce the risk of developing cardiovascular diseases and preventing age-related illness.
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Affiliation(s)
| | - Miran Čoklo
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Jasna Aladrović
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Anja Belavić
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Saša Missoni
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
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22
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Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
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23
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Flynn JT. Stability of Blood Pressure and Diagnosis of Hypertension in Childhood. Pediatrics 2020; 146:peds.2020-018481. [PMID: 32948659 DOI: 10.1542/peds.2020-018481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, School of Medicine, University of Washington; and Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
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24
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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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25
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Dionne JM. Evidence Gaps in the Identification and Treatment of Hypertension in Children. Can J Cardiol 2020; 36:1384-1393. [PMID: 32502426 DOI: 10.1016/j.cjca.2020.02.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/06/2020] [Indexed: 01/03/2023] Open
Abstract
The ultimate goal of recognizing and treating hypertension in childhood is to prevent target-organ damage during childhood and to reduce the risk of adulthood cardiovascular disease. The quality of evidence to guide blood pressure management in children is lower than in adult medicine, yet some common findings support clinical practice recommendations. Oscillometric devices are increasingly replacing manual blood pressure measurements, but evidence shows that readings are not equivalent between the 2 methods. In addition, multiple blood pressure readings are needed before diagnosing a child with hypertension, but the optimal number and timing are still being determined. The recent American Academy of Pediatrics blood pressure guideline has revised the normative data tables and included threshold blood pressure limits which seem to identify children with higher cardiovascular risks. Threshold limits vary between guidelines, and the most accurate threshold has yet to be determined. Lifestyle modifications are a cornerstone of hypertension management, but the optimal diet and physical activity changes for beneficial effect are not known. When pharmacotherapy is needed, physicians have used drugs from all antihypertensive classes in children, yet only a few classes have been systematically studied. The long-term cardiovascular consequences of elevated blood pressure during childhood are under investigation and it seems that the lower the childhood blood pressure the better and that the rate of change during childhood is predictive of adulthood disease. With much still to learn, this article summarizes the evidence and the evidence gaps for the diagnosis, investigation, management, and outcomes of pediatric hypertension.
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Affiliation(s)
- Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
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26
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Pais P, Dello Strologo L, Iyengar A, Velusamy V, Greenbaum LA. Nocturnal hypertension and left ventricular hypertrophy in pediatric renal transplant recipients in South India. Pediatr Transplant 2020; 24:e13710. [PMID: 32320120 DOI: 10.1111/petr.13710] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
HTN after renal transplantation is associated with cardiovascular morbidity. ABPM allows diagnosis of masked HTN and isolated nocturnal HTN. Longitudinal ABPM data in children post-transplant are limited. ABPM was performed in children post-transplant and repeated in 6-12 months. BP indices were used to determine the prevalence of masked HTN, masked uncontrolled HTN (masked HTN in patients on antihypertensive medications), and isolated nocturnal HTN. Linear regression determined the association between LVMI and ABPM indices. Thirty children underwent a baseline ABPM. Ambulatory HTN was present in 25 (83%). Masked HTN was present in 18 (60%) and isolated nocturnal HTN in 13 (43%). Nocturnal ambulatory BP was higher than corresponding daytime BPs (P < .001 for systolic and diastolic) and 25 (83%) had a blunted nocturnal dip. Prednisone dose predicted nocturnal DBP index and DBP load (r2 = .40, P = .024 and r2 = .178, P = .02). ABPM was repeated in 18 patients within 11 (±3) months. BP indices decreased with time, but nocturnal BPs remained higher than daytime (P < .001 for SBP and DBP). Blunted nocturnal dip did not improve. LVH was present in 12 (57%). LVMI was directly related to the nocturnal SBP index (r2 = .377, P = .003) and nocturnal DBP index (r2 = .493, P < .001). We found no association between LVMI and daytime BP indices. The prevalence of masked HTN, isolated nocturnal HTN, and blunted nocturnal dip was high in children with kidney transplants. Nocturnal BP predicted LVMI. Ambulatory BP improved on longitudinal follow-up, but the pattern of isolated nocturnal HTN persisted.
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Affiliation(s)
- Priya Pais
- Department of Pediatric Nephrology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - Luca Dello Strologo
- Pediatric Nephrology and Renal Transplant Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - Vasanthakumar Velusamy
- Division of Clinical Research and Training, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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27
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Simpson JM, Sinha MD. Cardiac Function in Young Patients With Elevated Blood Pressure. Hypertension 2020; 75:1417-1418. [PMID: 32401644 DOI: 10.1161/hypertensionaha.120.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John M Simpson
- From Kings College London, United Kingdom (J.M.S., M.D.S.).,Department of Congenital Heart Disease (J.M.S.) and Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas NHS Trust, United Kingdom
| | - Manish D Sinha
- From Kings College London, United Kingdom (J.M.S., M.D.S.)
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28
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Becker RC, Phillip Owens A, Sadayappan S. The potential roles of Von Willebrand factor and neutrophil extracellular traps in the natural history of hypertrophic and hypertensive cardiomyopathy. Thromb Res 2020; 192:78-87. [PMID: 32460175 DOI: 10.1016/j.thromres.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/09/2023]
Abstract
Inflammation is often applied broadly to human disease. Despite its general familiarity, inflammation is highly complex. There are numerous injurious, immune and infectious determinants, functional elements and signaling pathways, ranging from genetic to epigenetic, environmental, racial, molecular and cellular that participate in disease onset and progression, phenotypic heterogeneity, and treatment selection and response. In addition, inflammation can be tissue and organ specific, adding a layer of complexity to achieving a detailed and translatable understanding of its role in health and disease. The following review takes a close look at inflammation in the context of two common heart diseases, hypertrophic cardiomyopathy and hypertensive cardiomyopathy.
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Affiliation(s)
- Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung and Blood Institute, University of Cincinnati College of Medicine, United States of America.
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease, Heart, Lung and Blood Institute, University of Cincinnati College of Medicine, United States of America
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Heart, Lung and Blood Institute, University of Cincinnati College of Medicine, United States of America
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Tran AH, Flynn JT, Becker RC, Daniels SR, Falkner BE, Ferguson M, Hanevold CD, Hooper SR, Ingelfinger JR, Lande MB, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels JA, Urbina EM. Subclinical Systolic and Diastolic Dysfunction Is Evident in Youth With Elevated Blood Pressure. Hypertension 2020; 75:1551-1556. [PMID: 32362230 PMCID: PMC7266265 DOI: 10.1161/hypertensionaha.119.14682] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is associated with cardiovascular events in adults. Subclinical changes to left ventricular strain and diastolic function have been found before development of decreased left ventricular ejection fraction and cardiovascular events. Our objective was to study effects of blood pressure (BP) on ventricular function in youth across the BP spectrum. Vital signs and labs were obtained in 346 participants aged 11 to 19 years who had BP categorized as low-risk (N=144; systolic BP <75th percentile), mid-risk (N=83; systolic BP ≥80th and <90th percentile), and high-risk (N=119; systolic BP ≥90th percentile). Echocardiography was performed to assess left ventricular strain and diastolic function. Differences between groups were analyzed by ANOVA. General linear models were constructed to determine independent predictors of systolic and diastolic function. Mid-risk and high-risk participants had greater adiposity and more adverse metabolic labs (lower HDL [high-density lipoprotein], higher glucose, and higher insulin) than the low-risk group. Mid-risk and high-risk participants had significantly lower left ventricular ejection fraction and peak global longitudinal strain than the low-risk group (both P≤0.05). The E/e' ratio was higher in the high-risk group versus the low-risk and mid-risk groups, and the e'/a' ratio was lower in the high-risk versus the low-risk group (both P≤0.05). BP and adiposity were statistically significant determinants of left ventricular systolic and diastolic function. Subclinical changes in left ventricular systolic and diastolic function can be detected even at BP levels below the hypertensive range as currently defined.
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Affiliation(s)
- Andrew H Tran
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.).,The Ohio State University, OH (A.H.T.).,Nationwide Children's Hospital, Columbus, OH (A.H.T.)
| | | | - Richard C Becker
- University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
| | | | | | | | | | - Stephen R Hooper
- School of Medicine, University of North Carolina at Chapel Hill (S.R.H.)
| | | | - Marc B Lande
- University of Rochester Medical Center, New York (M.B.L.)
| | - Lisa J Martin
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
| | | | | | - Elaine M Urbina
- From the Cincinnati Children's Hospital Medical Center, OH (A.H.T., L.J.M., M.M., E.M.U.).,University of Cincinnati, OH (A.H.T., R.C.B., L.J.M., M.M., E.M.U.)
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30
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Kelly A, Magge SN, Walega R, Cochrane C, Pipan ME, Zemel BS, Cohen MS, Gidding SS, Townsend R. Cross-Sectional Study of Arterial Stiffness in Adolescents with Down Syndrome. J Pediatr 2019; 212:79-86.e1. [PMID: 31201031 PMCID: PMC6754250 DOI: 10.1016/j.jpeds.2019.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To test whether youth with Down syndrome have aortic stiffness indices, as measured by pulse wave velocity (PWV), that differ from youth without Down syndrome and to compare reference-based age-adjusted (age-PWV-Z) and height-adjusted (Ht-PWV-Z) in youth with and without Down syndrome. STUDY DESIGN Cross-sectional study of PWV in 129 adolescents with Down syndrome and 97 youth of comparable age, sex, race/ethnicity, and body mass index (BMI). PWV, age-PWV-Z, and Ht-PWV-Z were compared. Regression models were developed to test for associations with PWV. RESULTS Youth with Down syndrome and controls were comparable in BMI-Z (1.4 [-1.5 to 2.8] vs 1.2 [-2.0 to 2.8], P = .57) but not Ht-Z (-2.3 [-4.7 to 0.8] vs 0.4 [-2.0 to 2.6], P < .0001). PWV (m/s, 5.0 [3.1-7.9] vs 5.0 [3.6-8.0], P = .5) and mean arterial pressure (MAP, mm Hg) (78 [61-102] vs 74 [64-97], P = .09) were not different between groups. In adjusted analyses confined to Down syndrome, PWV was associated only with BMI, but not age, black race, or MAP (R2 = 0.11). In contrast, BMI, age, black race, and MAP were all positively associated with and better explained PWV in controls (R2 = 0.50). PWV was not associated with height in youth with or without Down syndrome. Although age-PWV-Z was not different in Down syndrome (-0.36 [-2.93 to 3.49]) vs -0.15 [-2.32 to 3.22]), Ht-PWV-Z was greater in Down syndrome (0.32 [-2.28 to 4.07] vs -0.08 [-2.64 to 2.64], P = .002), and Ht-PWV-Z was greater than age-PWV-Z in Down syndrome (P < .0001). CONCLUSIONS The lack of relationship of PWV, an independent predictor of adult cardiovascular events, with its traditional determinants including MAP suggests Down syndrome-specific phenomena may alter such relationships in this population. In youth with Down syndrome, Ht-adjusted PWV may overestimate aortic stiffness. TRIAL REGISTRATION Clinicaltrials.gov: NCT01821300.
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Affiliation(s)
- Andrea Kelly
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA.
| | - Sheela N Magge
- Children's National Health System, Children's Research Institute, The George Washington University School of Medicine and Health Sciences, Division of Endocrinology and Diabetes and CTSI-CN, Washington, DC
| | - Rachel Walega
- Children's National Health System, Children's Research Institute, The George Washington University School of Medicine and Health Sciences, Division of Endocrinology and Diabetes and CTSI-CN, Washington, DC
| | - Claire Cochrane
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mary E Pipan
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA; Division of Developmental Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA; Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Meryl S Cohen
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Ray Townsend
- Department of Medicine, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA
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Urbina EM, Mendizábal B, Becker RC, Daniels SR, Falkner BE, Hamdani G, Hanevold C, Hooper SR, Ingelfinger JR, Lanade M, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels J, Flynn JT. Association of Blood Pressure Level With Left Ventricular Mass in Adolescents. Hypertension 2019; 74:590-596. [PMID: 31327264 DOI: 10.1161/hypertensionaha.119.13027] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80-<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m2.7; LVH: L=13%, M=21%, H=27%, all P<0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m2.7). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.
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Affiliation(s)
- Elaine M Urbina
- From the Division of Preventive Cardiology (E.M.U.), Cincinnati Children's Hospital Medical Center, OH
| | | | - Richard C Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.C.B.)
| | - Steve R Daniels
- Department of Pediatrics, Denver Children's Hospital, CO (S.D.)
| | - Bonita E Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.E.F.)
| | - Gilad Hamdani
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel (G.H.)
| | - Coral Hanevold
- Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.)
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine (S.R.H.)
| | - Julie R Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children, Massachusetts General Hospital, Boston (J.R.I.)
| | - Marc Lanade
- Department of Pediatrics, University of Rochester Medical Center, NY (M.L.)
| | - Lisa J Martin
- Division of Human Genetics (L.J.M.), Cincinnati Children's Hospital Medical Center, OH
| | - Kevin Meyers
- Division of Nephrology and Hypertension, Children's Hospital of Philadelphia, PA (K.M.)
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension (M.M.), Cincinnati Children's Hospital Medical Center, OH
| | | | - Joshua Samuels
- Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas in Houston (J.S.)
| | - Joseph T Flynn
- Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.)
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Taylor-Zapata P, Baker-Smith CM, Burckart G, Daniels SR, Flynn JT, Giacoia G, Green D, Kelly AS, Khurana M, Li JS, Pratt C, Urbina EM, Zajicek A. Research Gaps in Primary Pediatric Hypertension. Pediatrics 2019; 143:e20183517. [PMID: 31023830 PMCID: PMC6564054 DOI: 10.1542/peds.2018-3517] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
Hypertension affects >40% of the US population and is a major contributor to cardiovascular-related morbidity and mortality. Although less common among children and adolescents, hypertension affects 1% to 5% of all youth. The 2017 Clinical Practice Guideline for the Diagnosis and Management of High Blood Pressure in Children and Adolescents provided updates and strategies regarding the diagnosis and management of hypertension in youth. Despite this important information, many gaps in knowledge remain, such as the etiology, prevalence, and trends of hypertension; the utility and practicality of ambulatory blood pressure monitoring; practical goals for lifestyle modification that are generalizable; the long-term end-organ impacts of hypertension in youth; and the long-term safety and efficacy of antihypertensive therapy in youth. The Eunice Kennedy Shriver National Institute of Child Health and Human Development, in collaboration with the National Heart, Lung, and Blood Institute and the US Food and Drug Administration, sponsored a workshop of experts to discuss the current state of childhood primary hypertension. We highlight the results of that workshop and aim to (1) provide an overview of current practices related to the diagnosis, management, and treatment of primary pediatric hypertension; (2) identify related research gaps; and (3) propose ways to address existing research gaps.
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Affiliation(s)
- Perdita Taylor-Zapata
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development,
| | | | - Gilbert Burckart
- Office of Clinical Pharmacology, Immediate Office of the Commissioner, and
| | - Stephen R Daniels
- Department of Pediatrics, Section of Cardiology, School of Medicine, University of Colorado, Aurora, Colorado
| | - Joseph T Flynn
- School of Medicine, University of Washington, Seattle, Washington
| | - George Giacoia
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Dionna Green
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mona Khurana
- Division of Pediatric and Maternal Health, Office of New Drugs
| | - Jennifer S Li
- Department of Pediatrics, Duke University, Durham, North Carolina; and
| | - Charlotte Pratt
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, and
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Zajicek
- Office of Clinical Research Training and Medical Education, National Institutes of Health, Bethesda, Maryland
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33
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Hypertension Editors' Picks. Hypertension 2019; 73:e67-e82. [PMID: 31030605 DOI: 10.1161/hypertensionaha.119.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ambulatory blood pressure monitoring tolerability and blood pressure status in adolescents: the SHIP AHOY study. Blood Press Monit 2019; 24:12-17. [PMID: 30451702 DOI: 10.1097/mbp.0000000000000354] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) provides a more precise assessment of blood pressure (BP) status than clinic BP and is currently recommended in the evaluation of elevated BP in children and adolescents. Yet, ABPM can be uncomfortable for patients and cumbersome to perform. OBJECTIVE Evaluation of the tolerability to ABPM in 232 adolescent participants (median age: 15.7 years, 64% white, 16% Hispanic, 53% male) in the Study of Hypertension In Pediatrics Adult Hypertension Onset in Youth and its potential effects on ABPM results. PARTICIPANTS AND METHODS Ambulatory BP status (normal vs. hypertension) was determined by sex and height-specific pediatric cut-points. Participants were asked to rank their wake and sleep tolerability to ABPM from 1 (most tolerant) to 10 (least tolerant); those with tolerability score of at least 8 were considered ABPM intolerant. RESULTS Forty-three (19%) participants had wake ambulatory hypertension (HTN), 42 (18%) had sleep ambulatory HTN, and 64 (28%) had overall (wake and/or sleep) ambulatory HTN. Forty (17%) participants were intolerant to ABPM during wake hours and 58 (25%) were intolerant during sleep. ABPM intolerance during wake (but not sleep) hours was independently associated with wake (odds ratio: 2.34, 95% confidence interval: 1.01-5.39) and overall (odds ratio: 2.94, 95% confidence interval: 1.21-7.18) ambulatory HTN. CONCLUSION Poor tolerability to ABPM is associated with a higher prevalence of ambulatory HTN in adolescents, and should be taken into consideration at time of ABPM interpretation.
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35
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Affiliation(s)
- Marc B Lande
- From the Department of Pediatrics, University of Rochester, NY (M.B.L.)
| | - Donald L Batisky
- Department of Pediatrics, Emory University, Atlanta, GA (D.L.B.)
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36
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Hamdani G, Flynn JT, Becker RC, Daniels SR, Falkner B, Hanevold CD, Ingelfinger JR, Lande MB, Martin LJ, Meyers KE, Mitsnefes M, Rosner B, Samuels JA, Urbina EM. Prediction of Ambulatory Hypertension Based on Clinic Blood Pressure Percentile in Adolescents. Hypertension 2018; 72:955-961. [PMID: 30354718 PMCID: PMC7202372 DOI: 10.1161/hypertensionaha.118.11530] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022]
Abstract
Ambulatory blood pressure (BP) monitoring provides a more precise measure of BP status than clinic BP and is currently recommended in the evaluation of high BP in children and adolescents. However, ambulatory BP monitoring may not always be available. Our aim was to determine the clinic BP percentile most likely to predict ambulatory hypertension. We evaluated clinic and ambulatory BP in 247 adolescents (median age, 15.7 years; 63% white; 54% male). Clinic BP percentile (based on the fourth report and the 2017 American Academy of Pediatrics clinical practice guidelines) and ambulatory BP status (normal versus hypertension) were determined by age-, sex-, and height-specific cut points. Sensitivity and specificity of different clinic BP percentiles and cutoffs to predict ambulatory hypertension were calculated. Forty (16%) and 67 (27%) patients had systolic hypertension based on the fourth report and the 2017 guidelines, respectively, whereas 38 (15%) had wake ambulatory systolic hypertension. The prevalence of ambulatory wake systolic hypertension increased across clinic systolic BP percentiles, from 3% when clinic systolic BP was <50th percentile to 41% when ≥95th percentile. The 2017 guidelines' 85th systolic percentile had similar sensitivity (86.8%) and better specificity (57.4% versus 48.1%) than elevated BP (≥90th percentile or ≥120 mm Hg) to diagnose ambulatory hypertension. When evaluating adolescents for hypertension, 2017 guidelines' clinic systolic 85th percentile may be the optimal threshold at which to perform ambulatory BP monitoring.
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Affiliation(s)
- Gilad Hamdani
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | - Joseph T Flynn
- Seattle Children's Hospital, Washington (J.T.F., C.D.H.)
| | | | | | - Bonita Falkner
- Thomas Jefferson University Hospital, Philadelphia, PA (B.F.)
| | | | | | - Marc B Lande
- University of Rochester Medical Center, New York (M.B.L.)
| | - Lisa J Martin
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | | | - Mark Mitsnefes
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
| | - Bernard Rosner
- Harvard TH Chan School of Public Health, Boston, MA (B.R.)
| | | | - Elaine M Urbina
- From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.)
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