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Association Between Adiposity and Left Ventricular Mass in Children With Hypertension

Tammy M Brady1, Lawrence J Appel2, Kathryn W Holmes3

  • 1Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.

Journal of Clinical Hypertension (Greenwich, Conn.)
|November 5, 2015
PubMed

Insights

Obesity worsens left ventricular hypertrophy (LVH) in hypertensive children, increasing left ventricular mass index (LVMI) over time. Adiposity, not just blood pressure, is a key factor in pediatric hypertensive heart disease progression.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Disease Risk Factors
  • Hypertension Research

Background:

  • Left ventricular hypertrophy (LVH) is common in children with hypertension.
  • Blood pressure alone does not reliably predict LVH presence in this population.
  • Obesity is an emerging concern in pediatric hypertension and its cardiovascular sequelae.

Purpose of the Study:

  • To investigate the association between obesity-related risk factors and left ventricular mass index (LVMI) in hypertensive children.
  • To determine if adiposity's effect on LVMI is mediated by blood pressure-dependent or -independent pathways.
  • To examine the longitudinal changes in LVMI related to weight status over one year.

Main Methods:

  • A 1-year prospective cohort study involving 49 hypertensive children.
  • Assessment of baseline and follow-up measurements including LVMI, body mass index z-score, and blood pressure parameters.
  • Statistical analysis to identify associations between adiposity, blood pressure, and LVMI changes.

Main Results:

  • Over half (51%) of the children were overweight or obese at baseline.
  • Children who were overweight/obese showed a significantly greater increase in LVMI compared to normal-weight peers (6.4 vs. 0.95 g/m(2.7)).
  • Baseline body mass index z-score was an independent predictor of LVMI change (β=4.08, P=.002), with partial mediation by pulse pressure and aldosterone.

Conclusions:

  • Adiposity is strongly associated with LVH and increasing LVMI in hypertensive children.
  • Obesity represents a critical, modifiable risk factor driving cardiac changes in pediatric hypertension.
  • Hypertensive youth exhibit multiple, worsening cardiovascular risk factors, highlighting the need for comprehensive management strategies.

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