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Published on: May 3, 2018
Cardiovascular implications in adolescent and young adult hypertension
Rupesh Raina1,2, Amrit Khooblall1, Raghav Shah1
1Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH 44307, USA.
Insights
Pediatric hypertension affects 4% of children and is linked to early cardiovascular changes like increased left ventricular mass index and aortic stiffness. Early diagnosis and treatment are crucial for long-term heart health.
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Pediatric hypertension is a significant health concern, affecting approximately 3.5% of children and adolescents in the U.S.
- It detrimentally impacts cardiovascular systems, measurable through left ventricular mass index (LVMI), left ventricular hypertrophy (LVH), carotid intima media thickness (cIMT), and aortic stiffness.
- Various underlying etiologies contribute to pediatric hypertension, including kidney disease, congenital conditions, endocrine disorders, sleep apnea, and certain medications.
Purpose of the Study:
- To synthesize current clinical data on pediatric hypertension.
- To analyze the prevalence and cardiovascular impact of hypertension in children and adolescents.
- To highlight the importance of early detection and management of pediatric hypertension.
Main Methods:
- An extensive literature search was performed for clinical data on pediatric hypertension.
- Sixty-seven articles, encompassing data from 189,477 subjects, were included in the analysis.
- Extracted data focused on hypertension incidence, LVMI, LVH, cIMT, and aortic stiffness.
Main Results:
- The average prevalence of pediatric hypertension (age < 18) from 1994-2018 was 4%.
- Hypertensive children showed higher average LVMI (39.3 g/m²) and cIMT (0.55 mm) compared to controls (30.1 g/m² and 0.49 mm, respectively).
- Hypertensive subjects exhibited significantly increased SBP, DBP, MAP, and PP in ambulatory arterial stiffness parameters compared to normotensive individuals.
Conclusions:
- Pediatric hypertension is associated with early signs of cardiovascular disease, evidenced by elevated LVMI, LVH, cIMT, and arterial stiffness.
- Non-invasive measures confirm target organ damage in hypertensive children.
- Prompt diagnosis and treatment of high blood pressure in pediatric populations are essential for preventing long-term cardiovascular morbidity and mortality.
Background:
Hypertension is one of the most prevalent diseases in the United States, affecting an estimated 3.5% of children and adolescents. It can be adversely affect most organ systems but is particularly detrimental to the heart and vascular systems. The repercussions can be gauged through well-established measures of cardiovascular function including left ventricular mass index (LVMI), left ventricular hypertrophy (LVH), carotid intima media thickness (cIMT), and aortic stiffness. Cardiovascular function is also affected by underlying etiologies of hypertension including chronic kidney disease, polycystic kidney disease, coarctation of the aorta, adrenal disorders, renal artery stenosis, obstructive sleep apnea, as well as various drugs and medications (decongestants, stimulants, Non-steroidal Anti-inflammatory Drugs (NSAIDs), and steroids).
Methods:
An exhaustive literature search was conducted for clinical data regarding pediatric hypertension. Sixty-seven articles were incorporated with data on 189,477 subjects total. The data was then extracted and categorized as relating to hypertension incidence, LVMI, LVH, cIMT, and/or aortic stiffness.
Results:
The prevalence of pediatric ( 18 years) hypertension extracted from 47 studies from 1994 to 2018 averaged 4%. The LVMI assessed over 7 studies (n = 661) averaged 39.3 g/ in the hypertensive cohort and 30.1 g/ in the control cohort. The cIMT assessed over 7 studies (n = 580) averaged 0.55 mm in the hypertensive cohort and 0.49 mm in the control cohort. Ambulatory arterial stiffness parameters assessed over 5 studies (n = 573) in the normotensive cohort averaged 99.73 mmHg, 69.81 mmHg, 76.85 mmHg, and 46.90 mmHg, for SBP, DBP, MAP, and PP respectively. Ambulatory arterial stiffness parameters assessed over 5 studies (n = 573) in the hypertensive cohort averaged 129.56 mmHg, 73.69 mmHg, 95.08 mmHg, and 56.80 mmHg, for SBP, DBP, MAP, and PP respectively.
Conclusions:
The significance of pediatric hypertension is emphasized by evidence of early cardiovascular disease as demonstrated by non-invasive measures including cIMT and arterial stiffness parameters, and target organ damage and including LVH and LVMI factors. Thus, early diagnosis and treatment of high blood pressure is paramount for improving long term cardiovascular health and preventing long term morbidity and mortality.
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