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Published on: November 21, 2013
Racial differences among children with primary hypertension
Tammy M Brady1, Barbara Fivush, Rulan S Parekh
1Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University, 200 N Wolfe St, 3062, Baltimore, MD 21287, USA. tbrady8@jhmi.edu
Insights
African American children with primary hypertension show higher cardiovascular risk, particularly those over 13. Overweight/obesity and left ventricular hypertrophy are prevalent in all youth with hypertension, necessitating increased prevention efforts.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Racial Disparities in Health
Background:
- Race is a significant risk factor for hypertension and cardiovascular disease in adults, influencing blood pressure (BP) in children.
- Primary hypertension in children is a growing concern, necessitating research into contributing factors and risk stratification.
Purpose of the Study:
- To investigate racial differences in clinical, laboratory, and echocardiographic characteristics among children diagnosed with primary hypertension.
- To determine if these differences vary based on age stratification.
Main Methods:
- A cohort of 184 children (3-20 years) with primary hypertension was analyzed at initial evaluation.
- Participants were categorized as African American (AA) or non-AA (nonblack).
- Comparisons were made for the entire group and stratified by age (<13 or ≥13 years).
Main Results:
- African American (AA) children exhibited higher rates of overweight/obesity, left ventricular hypertrophy, and elevated plasma renin activity compared to non-AA children.
- These disparities were significant in children younger than 13.
- In children aged 13 and older, AA children had significantly higher casual and ambulatory blood pressure measurements, including diastolic BP and BP loads.
Conclusions:
- Black children with primary hypertension face a higher cardiovascular risk than their nonblack counterparts.
- The high prevalence of overweight/obesity and left ventricular hypertrophy across all youth with primary hypertension underscores the urgent need for enhanced preventive and therapeutic strategies.
- Targeted interventions are crucial to mitigate cardiovascular risk in this vulnerable pediatric population.
Objective:
Race is a known risk factor for hypertension and cardiovascular disease in adults and influences blood pressure (BP) in children. We sought to determine if there are differences in clinical, laboratory, or echocardiographic characteristics among children with primary hypertension from different racial groups.
Patients And Methods:
Study participants were 184 children aged 3 to 20 years with a diagnosis of primary hypertension who were examined at 1 of 3 participating centers at the time of initial evaluation of elevated BP. Black children were categorized as African American (AA) and nonblack children as non-AA. Comparisons were made for the entire group and after stratification according to age (<13 or ≥ 13 years).
Results:
Overall, children categorized as AA had a higher prevalence of overweight/obesity and left ventricular hypertrophy and had higher plasma renin activity than children who were categorized as non-AA. After age stratification, these differences remained only in the children younger than 13 years old; there were no differences in these findings among children aged 13 years or older. AA children who were aged 13 years or older, however, had higher BPs for both casual and ambulatory measurements. Specifically, they had higher casual diastolic BP, higher 24-hour diastolic BP, higher daytime systolic and diastolic BP, and higher BP loads at night and over a 24-hour period compared with non-AA children who were aged 13 years or older.
Conclusions:
These data indicate that black children with primary hypertension may be at increased cardiovascular risk compared with nonblack children with primary hypertension. However, the high prevalence of overweight/obesity and left ventricular hypertrophy in all youth with primary hypertension demonstrates the need for greater preventive and therapeutic efforts aimed at reducing cardiovascular risk in this vulnerable population.
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