Skip to main content

Advertisement

SpringerLink
Log in

Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The purpose of this study was to investigate differences in left ventricular mass index (LVMI) and the prevalence of left ventricular hypertrophy (LVH) in children and adolescents classified as normotensives, prehypertensives and hypertensives by ambulatory blood pressure (BP) levels. A total of 124 consecutive children and adolescents aged 5 to 18 years were analysed. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography. Hypertensive and prehypertensive subjects had significantly higher LVMI than normotensives (36.8 ± 8.4 g/m2.7 and 34.1 ± 3.4 g/m2.7 vs. 29.5 ± 8.3 g/m2.7, P < 0.01 and P < 0.05, respectively). In multivariate analysis predictors for LVMI were body mass index (BMI) z score and hypertension (R-squared = 0.31). LVMI values in hypertensive subjects were significantly higher than those of normotensives even after adjustment for age, sex and BMI z score. The prevalence of LVH was significantly higher in the prehypertensive compared to normotensive subjects, and was equal to that of the hypertensive subjects. Hypertension and prehypertension in children and adolescents were associated with pathologically elevated LVMI values. If confirmed in a larger group prehypertensive children may be at risk for target organ damage similar to the condition of established hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Academy of Pediatrics, National High Blood Pressure Educational Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  2. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322:1561–1566

    Article  CAS  Google Scholar 

  3. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062

    Article  Google Scholar 

  4. Vakili BA, Okin PM, Devereux RB (2001) Prognostic implications of left ventricular hypertrophy. Am Heart J 141:334–341

    Article  CAS  Google Scholar 

  5. Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanian A (1991) High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension 17:22–27

    Article  CAS  Google Scholar 

  6. Falkner B, Gidding SS, Portman R, Rosner B (2008) Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics 122:238–242

    Article  Google Scholar 

  7. Toikka JO, Laine H, Ahotupa M, Haapanen A, Viikari JS, Hartiala JJ, Raitakari OT (2000) Increased arterial intima-media thickness and in vivo LDL oxidation in young men with borderline hypertension. Hypertension 36:929–933

    Article  CAS  Google Scholar 

  8. Markus MR, Stritzke J, Lieb W, Mayer B, Luchner A, Döring A, Keil U, Hense HW, Schunkert H (2008) Implications of persistent prehypertension for ageing-related changes in left ventricular geometry and function: the MONICA/KORA Augsburg study. J Hypertens 26:2040–2049

    Article  CAS  Google Scholar 

  9. Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG, Russell M, Devereux RB (2007) Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults: the Strong Heart Study. Circulation 115:221–227

    Article  Google Scholar 

  10. Russell LB, Valiyeva E, Carson JL (2004) Effects of prehypertension on admissions and deaths: a simulation. Arch Intern Med 164:2119–2124

    Article  Google Scholar 

  11. Zhang Y, Lee ET, Devereux RB, Yeh J, Best LG, Fabsitz RR, Howard BV (2006) Prehypertension, diabetes, and cardiovascular disease risk in a population-based sample: the Strong Heart Study. Hypertension 47:410–414

    Article  CAS  Google Scholar 

  12. Graves JW, Althaf MM (2006) Utility of ambulatory blood pressure monitoring in children and adolescents. Pediatr Nephrol 21:1640–1652

    Article  Google Scholar 

  13. Lurbe E, Redon J (2008) Discrepancies in office and ambulatory blood pressure in adolescents: help or hindrance? Pediatr Nephrol 23:341–345

    Article  Google Scholar 

  14. Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S, American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 52:433–451

    Article  CAS  Google Scholar 

  15. Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N (2005) Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension 45:602–607

    Article  CAS  Google Scholar 

  16. Kotsis V, Stabouli S, Pitiriga V, Toumanidis S, Papamichael C, Zakopoulos N (2006) Ambulatory blood pressure monitoring and target organ damage: effects of age and sex. Blood Press Monit 11:9–15

    Article  Google Scholar 

  17. Kotsis V, Stabouli S, Toumanidis S, Papamichael C, Lekakis J, Germanidis G, Hatzitolios A, Rizos Z, Sion M, Zakopoulos N (2008) Target organ damage in “white coat hypertension” and “masked hypertension". Am J Hypertens 21:393–399

    Article  Google Scholar 

  18. Stabouli S, Kotsis V, Zakopoulos N (2007) Ambulatory blood pressure monitoring and target organ damage in pediatrics. J Hypertens 25:1979–1986

    Article  CAS  Google Scholar 

  19. Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, Wawer ZT, Grenda R (2006) Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819

    Article  Google Scholar 

  20. Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N (2005) Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr 147:651–656

    Article  Google Scholar 

  21. Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N (2005) White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 20:1151–1155

    Article  Google Scholar 

  22. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243

    Article  CAS  Google Scholar 

  23. Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric Hypertension (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007

    Article  Google Scholar 

  24. Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083

    Article  CAS  Google Scholar 

  25. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  CAS  Google Scholar 

  26. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, Alderman MH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260

    Article  Google Scholar 

  27. Daniels SR, Meyer RA, Liang YC, Bove KE (1988) Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. J Am Coll Cardiol 12:703–708

    Google Scholar 

  28. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ (2007) Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 150:640–644

    Article  Google Scholar 

  29. Belsha CW, Wells TG, McNiece KL, Seib PM, Plummer JK, Berry PL (1998) Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens 11:410–417

    Article  CAS  Google Scholar 

  30. Sorof JM, Cardwell G, Franco K, Portman RJ (2002) Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 39:903–908

    Article  CAS  Google Scholar 

  31. Stabouli S, Kotsis V, Karagianni C, Toumanidis S, Zakopoulos N, Constantopoulos A (2008) Left ventricular mass index in hypertensive children and adolescents. Pediatrics 25(121 Suppl):S96

    Google Scholar 

  32. McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T, Sorof JM, Portman RJ, National High Blood Pressure Education Program Working Group (2007) Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension 50:392–395

    Article  CAS  Google Scholar 

  33. Richey PA, Disessa TG, Hastings MC, Somes GW, Alpert BS, Jones DP (2008) Ambulatory blood pressure and increased left ventricular mass in children at risk for hypertension. J Pediatr 152:343–348

    Article  Google Scholar 

  34. 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 113:328–333

    Article  Google Scholar 

  35. Maggio AB, Aggoun Y, Marchand LM, Martin XE, Herrmann F, Beghetti M, Farpour-Lambert NJ (2008) Associations among obesity, blood pressure, and left ventricular mass. J Pediatr 152:489–493

    Article  Google Scholar 

  36. Litwin M, Sladowska J, Syczewska M, Niemirska A, Daszkowska J, Antoniewicz J, Wierzbicka A, Wawer ZT (2008) Different BMI cardiovascular risk thresholds as markers of organ damage and metabolic syndrome in primary hypertension. Pediatr Nephrol 23:787–796

    Article  Google Scholar 

Download references

Conflict of interest

none

Author information

Authors and Affiliations

  1. 2nd Department of Pediatrics, National and Kapodestrial University, Athens, Greece

    Stella Stabouli, Christince Karagianni & Andreas Constantopoulos

  2. Pediatric Intensive Care Unit, Hippokration Hospital, Thessaloniki, Greece

    Stella Stabouli

  3. Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Vasilios Kotsis

  4. University of Toronto, Ontario, Canada

    Zoe Rizos

  5. Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodestrial University, Athens, Greece

    Savvas Toumanidis & Nikos Zakopoulos

  6. 3 Filippoupoleos Street, 55132, Thessaloniki, Greece

    Stella Stabouli

Authors
  1. Stella Stabouli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vasilios Kotsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zoe Rizos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Savvas Toumanidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christince Karagianni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Constantopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nikos Zakopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stella Stabouli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stabouli, S., Kotsis, V., Rizos, Z. et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol 24, 1545–1551 (2009). https://doi.org/10.1007/s00467-009-1165-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-009-1165-2

Keywords

Search

Navigation