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Familial aggregation of first degree relatives of children with essential hypertension
Monesha Gupta-Malhotra1, Syed Shahrukh Hashmi2, Michelle S Barratt3
1a Department of Pediatric Cardiology , Johns Hopkins All Children's Hospital, Johns Hopkins University , Saint Petersburg , FL , USA.
Insights
Familial aggregation of essential hypertension (EH) is significantly higher in children with EH. A family history of EH in first-degree relatives, especially parents, improves prediction of childhood-onset EH.
Area of Science:
- Pediatric Cardiology
- Genetics
- Public Health
Background:
- Essential hypertension (EH) is a growing concern in pediatric populations.
- Identifying genetic predispositions is crucial for understanding EH etiology.
- Familial aggregation studies are key to pinpointing potential disease-causing genes.
Purpose of the Study:
- To determine the familial aggregation of EH in first-degree relatives of children diagnosed with EH.
- To assess the impact of parental EH status on the risk of childhood-onset EH.
Main Methods:
- A case-control study involving 153 families with children diagnosed with EH and control families.
- Rigorous blood pressure (BP) measurement and diagnostic criteria for EH were employed.
- Parental EH status was confirmed via in-clinic direct BP measurements.
Main Results:
- Familial EH was over 3 times more likely in children with EH compared to controls (OR: 3.63).
- Having one parent with EH increased the odds almost 7-fold (OR: 6.92); two parents increased it 14-fold.
- The risk of EH was concentrated within first-degree relatives, not extending to second-degree relatives.
Conclusions:
- Childhood-onset EH exhibits significant familial aggregation, strongly linked to parental EH.
- The presence of EH in both parents confers a more than doubled risk compared to one parent.
- A family history of EH in first-degree relatives enhances the prediction of childhood-onset EH.
Purpose:
Determining familial aggregation is an important first step in narrowing the search for disease-causing genes and hence we determined the familial aggregation of EH among first degree relatives of children with EH.
Materials And Methods:
We prospectively enrolled children with EH along with their first degree relatives from a tertiary pediatric hypertension clinic in a large ambulatory care center. We utilized rigorous methodology for blood pressure (BP) measurements and diagnoses of EH to reduce the heterogeneity in the phenotype. For those enrolled, parental BP status was confirmed by in-clinic direct BP measurements. We also enrolled control children without EH along with their first degree relatives from the same pediatric ambulatory center.
Results:
In our case-control study of 153 families, the odds of having familial EH was more than 3 times higher among the cases than in controls (OR: 3.63, 95% CI: 1.85-7.12) with 71% of the cases and 41% of the controls reporting familial EH. One parent with EH was seen in 88% of the cases and 52% of the controls (OR: 6.92, 95% CI: 2.68-17.84). The odds of at least one parent (compared to neither) with EH was almost 7-fold higher, and odds of having two parents with EH was 14-fold higher among cases versus controls. The risk of EH did not go back from the first degree relative to the second degree relatives.
Conclusions:
We identified familial aggregation with an increased liability of childhood onset EH with parental EH. The risk of childhood onset EH is more than doubled in the presence of EH in both parents versus in a single parent. Prediction for childhood-onset EH is improved by obtaining a family history of EH in the first degree relatives.
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