Skip to main content

The Role of Obesity in the Development of Left Ventricular Hypertrophy Among Children and Adolescents

Current Hypertension Reports volume 18, Article number: 3 (2016) Cite this article

Abstract

Both obesity and hypertension have increased substantially among children over the last several decades. At the same time, mounting evidence has pointed to the role of these and other cardiovascular disease risk factors on the development of end organ damage such as left ventricular hypertrophy in children. While traditionally thought to occur in response to an increased afterload as in systemic hypertension, evidence demonstrates that obesity is associated with left ventricular hypertrophy independent of blood pressure. Both hemodynamic and non-hemodynamic factors contribute to the pathogenesis of obesity-related left ventricular remodeling. However, more contemporary research suggests that adiposity and blood pressure have a greater effect on left ventricular geometry when present together than when present alone. Normalization of left ventricular mass in obese hypertensive individuals requires achievement of both normotension and weight loss. Additional strategies are needed to promote the cardiovascular health of children, with greater emphasis placed on obesity prevention.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Abbreviations

BMI:

Body mass index

BP:

Blood pressure

CV:

Cardiovascular

CVD:

Cardiovascular disease

LV:

Left ventricular

LVH:

Left ventricular hypertrophy

LVM:

Left ventricular mass

LVMI:

Left ventricular mass index

RWT:

Relative wall thickness

SD:

Standard deviation

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–14.

    Article  CAS  PubMed  Google Scholar 

  2. Fixler DE, Laird WP, Fitzgerald V, Stead S, Adams R. Hypertension screening in schools: results of the Dallas study. Pediatrics. 1979;63:32–6.

    CAS  PubMed  Google Scholar 

  3. Sinaiko AR, Gomez-Marin O, Prineas RJ. Prevalence of “significant” hypertension in junior high school-aged children: the Children and Adolescent Blood Pressure Program. J Pediatr. 1989;114:664–9.

    Article  CAS  PubMed  Google Scholar 

  4. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475–82.

    Article  PubMed  Google Scholar 

  5. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150:640–4. 4 e1.

    Article  PubMed  Google Scholar 

  6. Maggio AB, Aggoun Y, Marchand LM, Martin XE, Herrmann F, Beghetti M, et al. Associations among obesity, blood pressure, and left ventricular mass. J Pediatr. 2008;152:489–93.

    Article  PubMed  Google Scholar 

  7. Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ. 2012;345:e4759.

    PubMed Central  Article  PubMed  Google Scholar 

  8. Berenson GS, Srinivasan SR, Bao W, Newman 3rd WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338:1650–6.

    Article  CAS  PubMed  Google Scholar 

  9. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.

    Article  CAS  PubMed  Google Scholar 

  10. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555–76. This describes the recommended evaluation and treatment approach for pediatric hypertension, including details regarding the role of echocardiography.

  11. Khoury PR, Mitsnefes M, Daniels SR, Kimball TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr. 2009;22:709–14. This provides age- and sex-specific left ventricular mass index percentiles for children, which is necessary in the diagnosis of left ventricular hypertrophy.

    Article  PubMed  Google Scholar 

  12. de Simone G, Daniels SR, Kimball TR, Roman MJ, Romano C, Chinali M, et al. Evaluation of concentric left ventricular geometry in humans: evidence for age-related systematic underestimation. Hypertension. 2005;45:64–8.

    Article  PubMed  Google Scholar 

  13. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Bartoccini C, et al. Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol. 1995;25:871–8.

    Article  CAS  PubMed  Google Scholar 

  14. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH. 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. 1995;25:1056–62.

    Article  PubMed  Google Scholar 

  15. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008;117:3171–80.

    PubMed Central  Article  PubMed  Google Scholar 

  16. Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. Pediatrics. 2007;120:340–5.

    Article  PubMed  Google Scholar 

  17. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011;128 Suppl 5:S213–56. Most recent guidelines regarding cardiovascular disease risk factor screening, evaluation and treatment in children. Provides specific dietary recommendations for cardiovascular risk reduction.

  18. Hanevold C, Waller J, Daniels S, Portman R, Sorof J. 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. 2004;113:328–33.

    Article  PubMed  Google Scholar 

  19. McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T, et al. Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension. 2007;50:392–5.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  20. Sorof JM, Alexandrov AV, Cardwell G, Portman RJ. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics. 2003;111:61–6.

    Article  PubMed  Google Scholar 

  21. Urbina EM, Khoury PR, McCoy C, Daniels SR, Kimball TR, Dolan LM. Cardiac and vascular consequences of pre-hypertension in youth. J Clin Hypertens (Greenwich). 2011;13:332–42.

    Article  Google Scholar 

  22. Stabouli S, Kotsis V, Rizos Z, Toumanidis S, Karagianni C, Constantopoulos A, et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol. 2009;24:1545–51.

    Article  PubMed  Google Scholar 

  23. Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr. 2008;152:73–8. 8 e1.

    Article  PubMed  Google Scholar 

  24. Pruette CS, Fivush BA, Flynn JT, Brady TM. Effects of obesity and race on left ventricular geometry in hypertensive children. Pediatr Nephrol. 2013;28:2015–22.

    Article  PubMed  Google Scholar 

  25. Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation. 1995;91:2400–6.

    Article  CAS  PubMed  Google Scholar 

  26. Crowley DI, Khoury PR, Urbina EM, Ippisch HM, Kimball TR. Cardiovascular impact of the pediatric obesity epidemic: higher left ventricular mass is related to higher body mass index. J Pediatr. 2011;158:709–14 e1.

    Article  PubMed  Google Scholar 

  27. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. 1991;266:231–6.

    Article  CAS  PubMed  Google Scholar 

  28. Dusan P, Tamara I, Goran V, Gordana ML, Amira PA. Left ventricular mass and diastolic function in obese children and adolescents. Pediatr Nephrol. 2015;30:645–52.

    Article  PubMed  Google Scholar 

  29. Sivanandam S, Sinaiko AR, Jacobs Jr DR, Steffen L, Moran A, Steinberger J. Relation of increase in adiposity to increase in left ventricular mass from childhood to young adulthood. Am J Cardiol. 2006;98:411–5.

    Article  PubMed  Google Scholar 

  30. Li X, Li S, Ulusoy E, Chen W, Srinivasan SR, Berenson GS. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study. Circulation. 2004;110:3488–92.

    Article  PubMed  Google Scholar 

  31. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008;88:389–419. Excellent, comprehensive review of the pathogenesis and mechanisms of obesity-related cardiac remodeling.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  32. Messerli FH, Christie B, DeCarvalho JG, Aristimuno GG, Suarez DH, Dreslinski GR, et al. Obesity and essential hypertension. Hemodynamics, intravascular volume, sodium excretion, and plasma renin activity. Arch Intern Med. 1981;141:81–5.

    Article  CAS  PubMed  Google Scholar 

  33. Bastien M, Poirier P, Lemieux I, Despres JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56:369–81.

    Article  PubMed  Google Scholar 

  34. Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11:85–97. Excellent review describing the role the dysfunctional adipocyte and various adipokines in cardiovascular disease and in the regulation of metabolic function.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  35. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479–82.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  36. Cloward TV, Walker JM, Farney RJ, Anderson JL. Left ventricular hypertrophy is a common echocardiographic abnormality in severe obstructive sleep apnea and reverses with nasal continuous positive airway pressure. Chest. 2003;124:594–601.

    Article  PubMed  Google Scholar 

  37. Murdolo G, Angeli F, Reboldi G, Di Giacomo L, Aita A, Bartolini C, et al. Left ventricular hypertrophy and obesity: only a matter of fat? High Blood Press Cardiovasc Prev. 2015;22:29–41. Excellent review describing the association of obesity with left ventricular hypertrophy, focusing on the role of the dysfunctional adipocyte, interstitial fat infiltration and the role of lipotoxicity.

    Article  CAS  PubMed  Google Scholar 

  38. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2:536–43.

    Article  PubMed  Google Scholar 

  39. Menzaghi C, Trischitta V, Doria A. Genetic influences of adiponectin on insulin resistance, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56:1198–209.

    Article  CAS  PubMed  Google Scholar 

  40. Kalil GZ, Haynes WG. Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications. Hypertens Res. 2012;35:4–16.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  41. Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008;51:1342–8.

    Article  PubMed  Google Scholar 

  42. Seeman T, Dostalek L, Gilik J. Control of hypertension in treated children and its association with target organ damage. Am J Hypertens. 2012;25:389–95.

    Article  CAS  PubMed  Google Scholar 

  43. Fagard RH, Celis H, Thijs L, Wouters S. Regression of left ventricular mass by antihypertensive treatment: a meta-analysis of randomized comparative studies. Hypertension. 2009;54:1084–91.

    Article  CAS  PubMed  Google Scholar 

  44. Gerdts E, de Simone G, Lund BP, Okin PM, Wachtell K, Boman K, et al. Impact of overweight and obesity on cardiac benefit of antihypertensive treatment. Nutr Metab Cardiovasc Dis. 2013;23:122–9.

    Article  CAS  PubMed  Google Scholar 

  45. de Simone G, Devereux RB, Izzo R, Girfoglio D, Lee ET, Howard BV, et al. Lack of reduction of left ventricular mass in treated hypertension: the strong heart study. J Am Heart Assoc. 2013;2:e000144.

    PubMed Central  Article  PubMed  Google Scholar 

  46. Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Janas R, Wawer ZT, et al. Regression of target organ damage in children and adolescents with primary hypertension. Pediatr Nephrol. 2010;25:2489–99.

    PubMed Central  Article  PubMed  Google Scholar 

  47. Brady TM, Appel LJ, Holmes KW, Fivush B, Miller ER, 3rd. Association between adiposity and left ventricular mass in children with hypertension. J Clin Hypertens (Greenwich).

  48. Lavie CJ, Messerli FH. Cardiovascular adaptation to obesity and hypertension. Chest. 1986;90:275–9. Excellent review of the independent and combined effects of obesity and blood pressure on the cardiovascular system.

    Article  CAS  PubMed  Google Scholar 

  49. Norton GR, Majane OH, Libhaber E, Maseko MJ, Makaula S, Libhaber C, et al. The relationship between blood pressure and left ventricular mass index depends on an excess adiposity. J Hypertens. 2009;27:1873–83.

    Article  CAS  PubMed  Google Scholar 

  50. Palatini P, Saladini F, Mos L, Benetti E, Bortolazzi A, Cozzio S, et al. Obesity is a strong determinant of hypertensive target organ damage in young-to-middle-age patients. Int J Obes (Lond). 2013;37:224–9.

    Article  CAS  Google Scholar 

  51. Lai CC, Sun D, Cen R, Wang J, Li S, Fernandez-Alonso C, et al. Impact of long-term burden of excessive adiposity and elevated blood pressure from childhood on adulthood left ventricular remodeling patterns: the Bogalusa Heart Study. J Am Coll Cardiol. 2014;64:1580–7.

    PubMed Central  Article  PubMed  Google Scholar 

  52. Gupta-Malhotra M, Hashmi SS, Poffenbarger T, McNiece-Redwine K. Left ventricular hypertrophy phenotype in childhood-onset essential hypertension. J Clin Hypertens (Greenwich).

  53. Daniels SR, Hassink SG. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136:e275–92.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None of the sponsors had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The first draft of this manuscript was written by Tammy M. Brady, and there was no honorarium, grant, or other form of payment given to anyone to produce the manuscript.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, 200 North Wolfe Street, #3062, Baltimore, MD, 21287, USA

    Tammy M. Brady

Authors
  1. Tammy M. Brady
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tammy M. Brady.

Ethics declarations

Conflict of Interest

Dr. Brady declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding Source

TMB is funded by the NIH/NHLBI (1K23 HL119622-01).

Additional information

This article is part of the Topical Collection on Pediatric Hypertension

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brady, T.M. The Role of Obesity in the Development of Left Ventricular Hypertrophy Among Children and Adolescents. Curr Hypertens Rep 18, 3 (2016). https://doi.org/10.1007/s11906-015-0608-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-015-0608-3

Keywords

  • Pediatrics
  • Blood pressure
  • Overweight
  • Youth
  • End organ damage
  • Cardiovascular disease