Skip to main content
Log in

Relation of Left Ventricular Hypertrophy to Microalbuminuria and C-Reactive Protein in Children and Adolescents with Essential Hypertension

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

Abstract

Microalbuminuria (MA) and C-reactive protein (CRP) levels are predictors of increased risk for left ventricular hypertrophy (LVH). Whether the strength of association between CRP and LVH is comparable to that of MA in hypertensive children is unknown. CRP and MA were measured in 64 children and adolescents with essential hypertension (HTN). In the entire population, CRP and MA showed positive relations with body mass index (BMI) (r = 0.30, p = 0.04 and r = 0.32, p = 0.04, respectively), systolic blood pressure (SBP) (r = 0.63, p = 0.03 and r = 0.58, p = 0.03, respectively), and LVH (r = 0.86, p < 0.001 and r = 0.81, p < 0.001, respectively). Patients with LVH (n = 23) had significantly higher BMI (p = 0.32), increased SBP (p = 0.031), and higher levels of CRP (p < 0.001) and MA (p < 0.001) compared with those without LVH. Multiple linear regression analysis demonstrated that CRP (r = 2.11, p < 0.001), MA (r = 1.94, p < 0.003), BMI (r = 0.53, p = 0.02), and SBP (r = 0.48, p = 0.04) were significantly associated with LVH. By analysis of covariance, CRP and MA were significantly different between patients who had LVH and those without LVH after adjustment for age, gender, BMI, SBP, SBP index, and diastolic blood pressure (p < 0.001 for the two markers). In conclusion, the strength of association between LVH and CRP is comparable to that of MA in children and adolescents with essential HTN.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Assadi F (2002) Quantitation of microalbuminuria using random urine samples. Pediatr Nephrol 17:107–110

    Article  PubMed  Google Scholar 

  2. Assadi F (2006) Effect of microalbuminuria-lowering on regression of left ventricular hypertrophy in children and adolescents with essential hypertension. Pediatric Cardiol 28:27–33

    Article  Google Scholar 

  3. Assadi F (2007) C-reactive protein and incident left ventricular hypertrophy in essential hypertension. Pediatr Cardiol 28:280–285

    Article  PubMed  Google Scholar 

  4. Briars GL, Bailey BG (1994) Surface area estimation: pocket calculator versus nomogram. Arch Dis Child 70:246–247

    Article  PubMed  CAS  Google Scholar 

  5. Cole Tj, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 320:1240–1243

    Article  CAS  Google Scholar 

  6. Daniels SR, Loggie JM, Khoury P, Kimball TR (1998) Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97:1907–1911

    PubMed  CAS  Google Scholar 

  7. Daniels SR, Kimball TR, Morrison JA, Khoury P, Meyer RA (1995) Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 76:699–701

    Article  PubMed  CAS  Google Scholar 

  8. Daniels SR, Kimball TR, Morrison JA, Khoury P, Witt S, Meyer RA (1995) Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents: Statistical, biological, and clinical significance. Circulation 92:3249–3254

    PubMed  CAS  Google Scholar 

  9. Devereux RB, Alonso DR, Lutas EM, et al. (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necroscopy findings. Am J Cardiol 57:450–458

    Article  PubMed  CAS  Google Scholar 

  10. de Simone G, Daniels SR, Devereux RB, et al. (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  PubMed  Google Scholar 

  11. 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  PubMed  Google Scholar 

  12. De Zeeuw (2004) Albuminuria, not only a cardiovascular/renal risk marker, but also a target for treatment? Kidney Int 66(Suppl 92):S2–S6

  13. Festa A, D’Agostino R, Howard G, Mykkanen L, Tracy RP, Haffner SM (2000) Inflammation and microalbuminuria in non diabetic and type 2 diabetic subjects: the insulin resistance atherosclerosis study. Kidney Int 58:1703–1710

    Article  PubMed  CAS  Google Scholar 

  14. Grandi AM, Santillo R, Bertolini A, et al. (2001) Microalbuminuria as a marker of preclinical diastolic dysfunction in never treated essential hypertensives. Am J Hypertens 14:644–648

    Article  PubMed  CAS  Google Scholar 

  15. Herbert LA, Wilmer WA, Falkenhain ME, Ladson-Wofford SE, Nahman NS Jr, Rovin BH (2001) Renoprotection: one or many therapies? Kidney Int 59:1211–1226

    Article  Google Scholar 

  16. Jensen JS, Feldt-Rasmussen BO, Strandgaard S, Schroll M, Borch-Johnson K (2000) Arterial hypertension, microalbuminuria, and risk of ischemic heart disease. Hypertension 35:898–903

    PubMed  CAS  Google Scholar 

  17. Keane WF, Eknoyan G (1999) Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J Kidney Dis 33:1004–1110

    Article  PubMed  CAS  Google Scholar 

  18. Litwin M, Niemirska A, Sladowska J, et al. (2006) Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819

    Article  PubMed  Google Scholar 

  19. Mattman A, Eintracht S, Mock T, et al. (2006) Estimating pediatric glomerular filtration rates in the era of chronic kidney disease staging. J Am Soc Nephrol 17:485–496

    Article  Google Scholar 

  20. Nakamura M, Onoda T, Itai K, et al.A (2004) Association between serum C-reactive protein levels and microalbuminuria: a population-based cross-sectional study in northern Iwate, Japan. Int Med 43:919–925

    Article  CAS  Google Scholar 

  21. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children, 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 

  22. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R (2002) Centers for Disease Control and Prevention 2000 growth charts for the united States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60

    Article  PubMed  Google Scholar 

  23. Pannacciulli N, Cantatore FP, Minenna M, Bellacicco M, Giorgino R, De Pergola G (2001) Urinary albumin excretion is independently associated with C-reactive protein levels in overweight and obese nondiabetic premenopausal women. J Int Med 250:502–507

    Article  CAS  Google Scholar 

  24. Ridker PM (2001) High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 103:1813–1818

    PubMed  CAS  Google Scholar 

  25. Ramaswamy P, Lytrivi ID, Paul C, Golden M, Kupferman JC (2007) Regression of left ventricular hypertrophy in children with antihypertensive therapy. Pediatr Nephrol 22:141–143

    Article  PubMed  Google Scholar 

  26. Ridker PM, Cannon CP, Morrow D, et al. (2005) C-Reactive protein levels and outcomes after statin therapy. N Engl J Med 352:20–28

    Article  PubMed  CAS  Google Scholar 

  27. Ridker PM, Hennekens CH, Buring JE, Rifai N (2000) C-Reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 342:836–843

    Article  PubMed  CAS  Google Scholar 

  28. Rutter Mk, Meigs JB, Sullivan LM, D’Agostina RB Sr, Wilson PW (2004) C-Reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham offspring study. Circulation 110:380–385

    Article  PubMed  CAS  Google Scholar 

  29. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) Predicting glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 106:522–526

    Google Scholar 

  30. Sorof J, Alexandrov AV, Garami Z, Turner JL, Grafe RE, Lai DL (2003) Carotid ultrasonography for detection of vascular abnormalities in hypertensive children. Pediatr Nephrol 18:1020–1024

    Article  PubMed  Google Scholar 

  31. Stuveling EM, Hillege HL, Bakker SJL et al. PREVEND Study Group (2004) C-reactive protein and microalbuminuria differ in their associations with various domains of vascular disease. Atherosclerosis 172:107–114

    Google Scholar 

  32. Tsioufis C, Dimitriadis K, Chatzis D, et al. (2005) Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in man with essential hypertension. Am J Cardiol 96:946–951

    Article  PubMed  CAS  Google Scholar 

  33. Viberti G, Wheeldon NM (2002) Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure independent effect. Circulation 106:672–678

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The author is indebted to John Bokowski with assistance in performing the echocardiography.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Farahnak Assadi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Assadi, F. Relation of Left Ventricular Hypertrophy to Microalbuminuria and C-Reactive Protein in Children and Adolescents with Essential Hypertension. Pediatr Cardiol 29, 580–584 (2008). https://doi.org/10.1007/s00246-007-9153-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-007-9153-4

Keywords

Navigation