[Changes in left ventricular geometry in children and adolescents with primary hypertension]
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Published on: February 13, 2021
1Dĕtské oddĕlení Nemocnice Trinec. stepan.rucki@nemtr.cz
Insights
Elevated blood pressure in children and adolescents is linked to left ventricular hypertrophy. Ambulatory blood pressure monitoring (ABPM) reveals significant correlations between higher blood pressure readings and increased left ventricular wall thickness and mass.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Hypertension Management
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular morbidity and mortality in adults.
- 24-hour ambulatory blood pressure monitoring (ABPM) offers superior correlation with organ damage compared to casual blood pressure measurements.
- Understanding LVH in pediatric populations with elevated blood pressure is crucial for early intervention.
Purpose of the Study:
- To investigate the relationship between 24-hour ABPM results and left ventricular geometry in children and adolescents with elevated blood pressure.
- To differentiate between sustained hypertension and white coat hypertension (WCH) using ABPM.
- To assess the impact of ambulatory BP levels on cardiac structure in young individuals.
Main Methods:
- 108 children and adolescents (ages 8-20) with elevated casual blood pressure underwent 24-hour ABPM and echocardiography.
- Participants with secondary causes of hypertension were excluded.
- Subjects were categorized into hypertensive (based on ABPM) and white coat hypertensive (WCH) groups.
Main Results:
- Hypertensive subjects exhibited significantly greater left ventricle posterior wall thickness and left ventricular mass index compared to WCH subjects.
- No significant differences in anthropometric data, including body mass index, were observed between groups.
- Strong correlations were found between ambulatory systolic blood pressure (diurnal and 24-hour) and left ventricular posterior wall thickness and mass index.
Conclusions:
- Hypertension, as documented by ABPM, is associated with increased left ventricle posterior wall thickness and mass index in pediatric patients.
- Ambulatory blood pressure monitoring is a valuable tool for identifying cardiac structural changes in children and adolescents.
- Diurnal systolic blood pressure showed the strongest correlation with left ventricular structural changes.
Background:
Left ventricular hypertrophy is an independent risk factor of cardiovascular morbidity and mortality in adults. The results of 24-hour ambulatory blood pressure monitoring (ABPM) correlate better with signs of organ damage than values of casual blood pressure. The objective of this study was to investigate the relationships between the results of 24-hour ABPM and left ventricular geometry in school-aged children and adolescents with elevated blood pressure.
Methods And Results:
24-hour ABPM and echocardiographic assessment of left ventricle were performed in 108 children and adolescents age 8-20 years (77 boys and 31 girls) with repeatedly elevated casual blood pressure (BP) values. Patients with secondary cause of hypertension were not included in this study. Based on ABPM results 57 patients out of total 108 had hypertension, the rest of 51 subjects had their ambulatory BP values below 95. percentil and were labelled as white coat hypertensive (WCH). The left ventricular measurements in hypertensive subject were higher when compared with WCH (left ventricle posterior wall thickness 8.4 +/- 1.0 mm in hypertensive vs. 8.0 +/- 1.1 mm in WHC (p = 0.047) and superscript left ventricular mass index 81.8 +/- 13.8 g/m2 vs 74.3 +/- 12 g/m2 respectively; p = 0.003). No differences were found in anthropometric data including body mass index in both groups. There was a significant correlation between ambulatory BP and both left ventricle posterior wall thickness and left ventricular mass index. The strongest correlation was found between diurnal systolic ambulatory BP and left ventricle posterior wall thickness (r = 0.42; p < 0.001) as well as between 24-hour and diurnal systolic ambulatory BP and left ventricular mass index (both r = 0.47; p < 0.001).
Conclusions:
Both left ventricle posterior wall thickness a left ventricle mass index are higher in patients with hypertension documented by ABPM compared with WCH subjects. The strongest correlation was found between diurnal systolic ambulatory BP and both left ventricle posterior wall thickness and left ventricular mass index.
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