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Systolic and diastolic left ventricular function in children with primary hypertension: a systematic review and
Rina R Rus1, Michał Pac2, Łukasz Obrycki2
1Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Insights
Children with primary hypertension show hyperkinetic left ventricular function, increased strain, and impaired diastolic function compared to healthy peers. This highlights early signs of target-organ damage in pediatric hypertension.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Hypertension in Children
Background:
- Left ventricular function evaluation is crucial for detecting early target-organ damage in pediatric primary hypertension.
- Primary hypertension in children and adolescents is an increasing concern with potential long-term cardiovascular consequences.
Conclusions:
- Children and adolescents with primary hypertension demonstrate hyperkinetic left ventricular function.
- Evidence suggests increased left ventricular strain and impaired diastolic function in hypertensive pediatric populations compared to normotensive controls.
- These findings underscore the importance of monitoring cardiac function for early detection of target-organ damage in pediatric hypertension.
Objective:
Evaluation of left ventricular function provides early evidence of target-organ damage in children with primary hypertension. We performed a systematic review and meta-analysis of left ventricular systolic and diastolic function in children and adolescents with primary hypertension.
Methods:
Literature search was performed in PubMed database and out of 718 articles (published between 2000 and 2021) 22 studies providing comparison of left ventricular function parameters between children with primary hypertension and normotensive controls were selected.
Results:
Overall, 3460 children (5-21 years) with primary hypertension were analyzed. Meta-analysis showed that hypertensive patients when compared with normotensives, had an increased heart rate (mean difference [MD] 5.59; 95% confidence interval [CI] 3.28, 7.89; 10 studies) and increased fractional shortening (MD 1.04; 95% CI 0.48, 1.60; 9 studies) but did not differ in ejection fraction (MD -0.03; 95% CI -1.07, 1.02; 12 studies). Stroke volume was higher in one out of three studies, whereas no differences in cardiac output were found in two studies with available data. Hypertensive children had also lower E/A values (MD -0.21; -0.33, -0.09; 14 studies), greater values of E/e' (MD 0.59; 0.36, 0.82; 8 studies) and greater global longitudinal stress (MD 2.50; 2.03, 2.96; 4 studies) when compared to those with normotension.
Conclusion:
Our results indicate that hypertensive children and adolescents present with signs of hyperkinetic function of the left ventricle, demonstrate evidence of increased left ventricular strain and impaired diastolic function compared to normotensive controls.
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