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Published on: June 5, 2019
Blood pressure variability in children with primary vs secondary hypertension
Daniel Leisman1, Melissa Meyers, Jeremy Schnall
1Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY.
Insights
Blood pressure variability (BPV) in children showed no strong link to primary versus secondary hypertension (HTN) overall. However, secondary HTN was associated with increased nighttime diastolic BPV, warranting further investigation.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Cardiovascular Physiology
Background:
- Increased blood pressure variability (BPV) is linked to adverse cardiovascular (CV) events in adults.
- Limited research exists on BPV's impact in pediatric populations.
- BPV differences between primary and secondary hypertension (HTN) in children are unknown.
Purpose of the Study:
- To investigate BPV in children with primary and secondary HTN.
- To compare BPV measures between pediatric primary and secondary HTN groups.
- To explore the association between BPV and left ventricular hypertrophy (LVH) in hypertensive children.
Main Methods:
- Seventy-four children (median age 13.5 years) with primary or secondary HTN underwent 24-hour ambulatory blood pressure monitoring and echocardiography.
- BPV metrics including standard deviation (SD) and average real variability (ARV) were calculated for 24-hour, daytime, and nighttime periods.
- Multiple regression analysis was used to identify predictors of BPV and associations with LVH.
Main Results:
- Body mass index z-score and age predicted systolic ARV and SD.
- No significant differences in overall or daytime BPV were found between primary and secondary HTN groups.
- Sleep period diastolic SD was significantly higher in the secondary HTN group and associated with secondary HTN on regression analysis.
- No BPV metrics were significantly associated with left ventricular hypertrophy (LVH).
Conclusions:
- This study found no strong association between overall or daytime BPV and primary versus secondary HTN in children.
- Secondary HTN is associated with increased sleep period diastolic BPV, meriting further research.
- BPV was not significantly associated with LVH in this pediatric cohort.
Abstract:
Increased blood pressure variability (BPV) is correlated with adverse cardiovascular (CV) events in adults. However, there has been limited research on its effect in the pediatric population. Additionally, BPV differences between primary and secondary hypertension (HTN) are not known. Children with primary and secondary HTN underwent 24-hour ambulatory blood pressure monitoring and echocardiography studies. BPV measures of standard deviation (SD), average real variability (ARV), and range were calculated for the 24-hour, daytime, and nighttime periods. Seventy-four patients (median age, 13.5 years; 74% boys) were examined, 40 of whom had primary HTN. Body mass index z score and age were independent predictors of systolic ARV (R(2) =0.14) and SD (R(2) =0.39). There were no statistically significant differences in overall or wake period BPV measures between secondary or primary HTN groups, but sleep period diastolic SD was significantly greater in the secondary HTN group (9.26±3.8 vs 7.1±2.8, P=.039). On multiple regression analysis, secondary HTN was associated with increased sleep period diastolic SD (P=.025). No metrics of BPV in the overall, wake, and sleep periods were found to be significantly associated with left ventricular hypertrophy (LVH). The results of this study do not show a strong relationship between overall or wake BPV with primary vs secondary HTN, but the association of secondary HTN with sleep period diastolic BPV deserves further exploration. Contrary to expectation, the findings of this study failed to indicate a relationship between BPV and LVH for all patients as well for primary hypertensive and secondary hypertensive patients.
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