Association of parental blood pressure with retinal microcirculatory abnormalities indicative of endothelial dysfunction in children
Muhammad Islam1, Tazeen H Jafar, Rasool Bux
1aClinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan bHealth Services & Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore cDivision of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA dNational Heart and Lung Institute, Imperial College London, London, UK *N.C. and A.D.H. contributed equally to the writing of the article.
Insights
Parental hypertension is linked to early microvascular changes in children, suggesting a genetic predisposition. Paternal blood pressure significantly impacts offspring retinal vessel abnormalities, even independent of the child's own blood pressure.
Area of Science:
- Cardiovascular Research
- Pediatric Health
- Ophthalmology
Background:
- Microcirculatory abnormalities are early indicators of hypertension risk.
- Familial clustering of hypertension suggests a genetic component.
- Understanding early vascular changes is crucial for predicting hypertension development.
Purpose of the Study:
- To investigate the association between parental blood pressure (BP) and offspring retinal microvasculature.
- To explore the role of parental hypertension in early-onset microvascular dysfunction.
- To examine these relationships in a Pakistani population.
Main Methods:
- Study included Pakistani trios (father, mother, child aged 9-14 years).
- Retinal vessel characteristics were measured from digital images.
- Multivariable linear regression analyzed associations between parental BP and offspring retinal microvasculature.
Main Results:
- Offspring of two hypertensive parents showed greater microvascular deviation.
- Paternal systolic and diastolic BP were significantly associated with offspring microvascular deviation.
- Maternal diastolic BP was inversely associated with the offspring arteriovenous ratio.
Conclusions:
- Childhood microvascular endothelial dysfunction correlates with parental hypertension levels.
- Paternal BP association with microvascular changes is independent of other cardiovascular risk factors.
- Early microcirculatory changes may explain familial hypertension predisposition.
Objective:
Microcirculatory abnormalities precede the onset of hypertension and may explain its familial nature. We examined the relationship between parental blood pressure (BP) and offspring retinal microvasculature in Pakistani trios [father, mother, and child (aged 9-14 years)].
Methods:
This is a substudy of a population-based trial of BP reduction. Data were available on 358 normotensive, and 410 offspring of at least one hypertensive parent. Retinal vessel characteristics were measured from digital images. Multivariable linear regression models were built to assess the associations between maternal and paternal BP and offspring retinal microvasculature.
Results:
Optimality deviation was greatest in offspring of two hypertensive parents, compared with those with one or no hypertensive parent (P=0.030 for trend). Paternal SBP and DBP were each significantly associated with optimality deviation in offspring (P=0.023 and P=0.006, respectively). This relationship persisted after accounting for offspring cardiovascular risk factors [increase in optimality deviation (95% confidence interval, CI) 0.0053 (0.0001-0.0106, P=0.047) and 0.0109 (0.0025-0.0193, P=0.011), for each 10 mmHg increase in paternal SBP and DBP, respectively]. Maternal DBP was inversely associated with offspring arteriovenous ratio -0.0102 (-0.0198 to -0.0007, P=0.035).
Conclusion:
Microvascular endothelial dysfunction in children is associated with increasing levels of parental hypertension. The association with paternal BP is independent of other cardiovascular risk factors, including the child's BP. Higher maternal DBP is associated with evidence of arteriolar narrowing in offspring. These early microcirculatory changes may help explain familial predisposition to hypertension in people of Pakistani origin at an early age.
Video Abstract:
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