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Determinants of cardiac involvement in children and adolescents with essential hypertension
S D Daniels1, R A Meyer, J M Loggie
1Division of Cardiology, University of Cincinnati College of Medicine, Ohio.
Insights
Left ventricular hypertrophy (LVH) is common in hypertensive children and adolescents. Factors like male sex, higher BMI, and sodium intake significantly influence LVH, suggesting lifestyle changes may help prevent it.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Hypertension Studies
Background:
- Systemic hypertension is linked to left ventricular hypertrophy (LVH), a risk factor for cardiovascular events.
- Determinants of left ventricular mass (LVM) in pediatric essential hypertension are not well-understood.
Purpose of the Study:
- To investigate the factors associated with LVM in children and adolescents with essential hypertension.
Main Methods:
- Echocardiography was used to determine LVM, indexed by height, in 104 children/adolescents with sustained hypertension.
- Multiple regression analysis identified correlates of LVM index.
Main Results:
- 38.5% of subjects exhibited LVH.
- Independent correlates of LVM index included male sex, BMI, dietary sodium, age at diagnosis, and peak exercise systolic blood pressure.
- Resting heart rate was an inverse correlate.
Conclusions:
- LVH is prevalent in pediatric essential hypertension.
- Body mass index and dietary sodium intake are significant direct correlates, suggesting weight reduction and salt restriction as potential interventions.
Abstract:
Left ventricular hypertrophy is often found in association with systemic hypertension and may be an independent risk factor for cardiovascular disease morbidity and mortality. Few studies have investigated the determinants of left ventricular mass (LVM) in young patients with essential hypertension. Therefore, we studied 104 children and adolescents with blood pressure persistently greater than the 90th percentile for age and sex and with no known cause of blood pressure elevation. LVM was determined by echocardiography and was indexed by height to account for body size. The mean LVM index was 90.2 +/- 26.0 g/m. Using the gender-specific 95th percentile from normal children, 40 subjects (38.5%) had left ventricular hypertrophy. Using multiple regression analysis, the significant independent direct correlates of LVM index were male sex, body mass index, dietary sodium intake, age at diagnosis, and systolic blood pressure at maximum exercise. The significant independent inverse correlate of LVM index was resting heart rate (p less than 0.05). These variables accounted for a substantial portion of the LVM index variance in this population (multiple R2 = 0.56, p less than 0.001). The results indicate that left ventricular hypertrophy is prevalent in children and adolescents with essential hypertension. The direct association of LVM index with body mass index and dietary sodium intake suggests weight reduction and dietary salt restriction might be useful to prevent or treat the development of left ventricular hypertrophy in pediatric patients with essential hypertension.