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Left ventricular geometry in children and adolescents with primary hypertension

Phyllis A Richey1, Thomas G Disessa, Grant W Somes

  • 1Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

American Journal of Hypertension
|October 24, 2009
PubMed

Insights

Children with hypertension and left ventricular hypertrophy (LVH) show higher blood pressure. Eccentric LVH in hypertensive children is linked to higher diastolic blood pressure, even after adjusting for BMI.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Hypertension Management

Background:

  • Children with hypertension (HTN) face an elevated risk of left ventricular hypertrophy (LVH).
  • Left ventricular (LV) remodeling can result in eccentric (increased diameter) or concentric (increased wall thickness) LV hypertrophy.
  • Understanding LV geometry is crucial for managing pediatric hypertension.

Purpose of the Study:

  • To classify left ventricular (LV) geometry in children with primary hypertension.
  • To investigate differences in ambulatory blood pressure (ABP) based on LV geometry.
  • To explore the relationship between LV geometry and blood pressure parameters in pediatric HTN.

Main Methods:

  • A cross-sectional study involving children aged 7-18 with suspected HTN.
  • Ambulatory blood pressure (ABP) and left ventricular mass index (LVMI) were measured within a 24-hour period.
  • LV geometry was categorized into normal, concentric remodeling, concentric LVH, or eccentric LVH.

Main Results:

  • Children with LVH exhibited higher ambulatory systolic and diastolic blood pressure (SBP/DBP) and BMI Z-scores.
  • 38% of hypertensive children (identified via ABPM) had LVH, with equal distribution between concentric and eccentric types.
  • Eccentric LVH was associated with significantly different 24-h DBP parameters compared to normal geometry and concentric LVH groups.
  • Relative wall thickness (RWT) showed an inverse association with nighttime DBP, persisting after BMI adjustment.

Conclusions:

  • Increased SBP and BMI Z-score are associated with LVH risk in children.
  • Eccentric LVH in hypertensive children is specifically linked to significantly higher diastolic blood pressure.
  • These findings highlight the importance of assessing LV geometry in pediatric hypertension management.
Abstract

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