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Prevalence and consequence of systolic hypertension in children
1Department of Pediatrics, University of Texas-Houston School of Medicine, 77030, USA. jonathan.m.sorof@uth.tmc.edu
Insights
Systolic blood pressure (SBP) elevation is a critical factor in childhood hypertension, impacting heart health. Focusing on normalizing SBP is crucial for treating pediatric hypertension and preventing related complications.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Cardiovascular Health
Background:
- Adult hypertension diagnosis and treatment heavily rely on systolic blood pressure (SBP).
- Emerging data indicate SBP elevation is a significant factor in childhood hypertension morbidity.
- Systolic hypertension is prevalent in children, detected through screening and in referred patients.
Purpose of the Study:
- To highlight the importance of SBP in pediatric hypertension.
- To emphasize the association between SBP and cardiovascular changes in children.
- To advocate for SBP normalization in pediatric hypertension treatment and research.
Main Methods:
- Review of epidemiological and pathophysiological data on adult and childhood hypertension.
- Analysis of studies linking SBP and diastolic blood pressure (DBP) to left ventricular mass (LVM) and hypertrophy (LVH) in children.
- Examination of prevalence data for LVH in hypertensive children.
Main Results:
- Mild-to-moderate BP elevation in children is linked to increased left ventricular mass (LVM).
- SBP shows a stronger correlation with left ventricular (LV) morphology than DBP in children.
- SBP is associated with increased LVM even within the normal SBP range.
- Left ventricular hypertrophy (LVH) prevalence in hypertensive children ranges from 30% to 70% and is more related to SBP than DBP.
Conclusions:
- Treatment of pediatric hypertension should prioritize SBP normalization, even if DBP is normal.
- SBP is a key indicator for cardiovascular risk in children with hypertension.
- Future antihypertensive medication trials in children should include SBP hypertension in their criteria.
Abstract:
Systolic blood pressure (SBP) has become the major criterion for the diagnosis, staging, and treatment of hypertension in adults, based on the epidemiology and pathophysiology of adult hypertension, linkage between SBP levels and disease, and benefits of treatment of isolated SBP hypertension. Although children do not typically suffer overt hypertensive disease, an accumulation of data suggests that SBP elevation is as important a factor in the morbidity of hypertension in children as in adults. Systolic BP hypertension is more common in children, whether examining an unselected sampling of patients by routine screening or a selected sampling of referred hypertensive patients. Mild-to-moderate BP elevation in children is associated with increased left ventricular mass (LVM), with SBP more closely linked to LV morphology than diastolic BP (DBP). Furthermore, SBP is associated with increased LVM even in patients with SBP within the normal range. Among hypertensive children, the reported prevalence of left ventricular hypertrophy (LVH) ranges from 30% to 70%, and LVH is more closely related to SBP than to DBP. These data suggest that treatment of hypertension should be directed at normalization of SBP, even when DBP is within the normal range. In addition, trials of antihypertensive medications in children should incorporate SBP hypertension into study inclusion criteria.