Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension
Our aim was to determine the prevalence of left ventricular hypertrophy (LVH) and increased intima-media thickness (IMT) in Caucasian children with newly diagnosed, untreated essential hypertension (EH).
Our study cohort consisted of 72 children with EH (mean age: 14.5 years; range: 5–18 years). The control groups consisted of 103 age-matched, healthy children.
We evaluated the left ventricular mass (LVM), intima-media thickness in the carotid (cIMT) and superficial femoral (fIMT) arteries, 24-h ambulatory blood pressure, and biochemical cardiovascular risk factors.
Of the hypertensive children examined, 41.6% had LVM above the 95th percentile, and 13.2% had LVM above 51 g/m2.7. Of the hypertensive subjects, the cIMT was above 2 SDS of normal values in 38.8%, and the flMT was above 2 SDS of normal values in 17.5%. Patients with LVM above 51 g/m2.7 had a higher birth weight than other patients. LVM, cIMT, and fIMT correlated with 24-h SBP and pulse pressure; LVM also correlated with homocysteine and serum uric acid concentrations. fIMT correlated with low Aprotein A1 (ApoA1), higher ApoB and C reactive protein, and daily sodium excretion. Step-wise regression analysis revealed that serum uric acid and higher birth weight were predictors for LVM, pulse pressure was a predictor for cIMT, and ApoB was a predictor for fIMT.
A significant number of adolescents with EH already had cardiovascular damage at diagnosis. LVM and markers of arterial injury correlate with SBP, biochemical, and perinatal cardiovascular risk factors. Serum uric acid and higher birth weight are predictors of LVM.
KeywordsChildren Essential hypertension Intima-media thickness Left ventricular hypertrophy Target organ damage
- 5.Hanevold C, Waller J, Daniels S, Portman R, Sorof J, International Pediatric Hypertension Association (2004) The effects of obesity, gender and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 113:328–333PubMedCrossRefGoogle Scholar
- 7.Litwin M, Trelewicz J, Wawer ZT, Antoniewicz J, Wierzbicka A, Grenda R (2004) Intima-media thickness and functional properties of arterial wall in elastic and muscular type arteries in children and adolescents with arterial hypertension: controlled study. Pediatr Nephrol 19:767–774PubMedCrossRefGoogle Scholar
- 9.(1996) Update on the 1987 Task Force on High Blood Pressure in Children and Adolescents: A Working Group Report from the National High Blood Pressure Education Program: working group on hypertension control in children and adolescents. Pediatrics 98:649–657Google Scholar
- 23.Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S (1999) Association between local pulse pressure, mean blood pressure and large artery remodelling. Hypertension 100:1387–1393Google Scholar
- 27.Urbina EM, Gidding SS, Bao W, Pickoff AS, Bardusis K, Berenson GS (1995) Effect of body size, ponderosity and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation 19:2400–2406Google Scholar
- 31.Olsen MH, Wechtell K, Hermann KL, Frandsen E, Diga-Petersen H, Deveraux RB, Ibsen H (2002) Is cardiovascular remodeling in patients with essential hypertension related to more than high blood pressure: a life substudy, Losartan Intervention for End-point reduction in Hypertension. Am J Hypertens 144:530–537Google Scholar
- 34.Kuznetsova T, Staessen JA, Stolarz K, Ryabikov A, Tikhonoff V, Olszanecka A, Bianchi G, Brand E, Casiglia E, Dominiczak A, Fagard R, Malyutina S, Nikitin Y, Kawecka-Jaszcz K European Project on Genes in Hypertension (EPOGH) Investigators (2004) Relationship between left ventricular mass and the ACE D/I polymorphism varies according to sodium intake. J Hypertens 22:287–295PubMedCrossRefGoogle Scholar
- 35.Harshfield GA, Koelsch DW, Pulliam DA, Alpert BS, Richey PA, Becker JA (2004) Racial differences in the age-related increase in left ventricular mass in youth. Hypertension 24:747–751Google Scholar
- 36.Feig DI, Johnson RJ (2003) Hyperuricemia in childhood essential hypertension. Hypertension 40:355–360Google Scholar
- 40.Glorioso N, Filigheddu F, Parpaglia PP, Soro A, Troffa C, G, Argiolas Mulatero P (2005) 11 β hydroxysteroid dehydrogenase type 2 is associated with left ventricular mass in essential hypertension. Eur Heart J 25:498–504Google Scholar