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Published on: May 3, 2018
Blood Pressure Variability and Low-Grade Inflammation in Pediatric Patients with Primary Hypertension
Katarzyna Dziedzic-Jankowska1, Michał Szyszka2, Adam Bujanowicz2
1Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland.
Insights
Children with primary hypertension exhibit higher blood pressure variability (BPV) and low-grade inflammation. The monocyte-to-neutrophil ratio (MNR) may indicate BPV, while lymphocyte count predicts non-dipping status in pediatric hypertension.
Area of Science:
- Pediatric Cardiology
- Hypertension Research
- Inflammation Studies
Background:
- Elevated blood pressure variability (BPV) is linked to cardiovascular risk in adults with primary hypertension (PH).
- The relationship between BPV and subclinical inflammation in pediatric PH is not well understood.
Purpose of the Study:
- To investigate the association between blood pressure variability (BPV) and markers of low-grade inflammation in children diagnosed with primary hypertension.
- To identify potential inflammatory predictors of BPV and non-dipping status in pediatric hypertension.
Main Methods:
- Ambulatory blood pressure monitoring (ABPM) was used to assess BPV in 56 children with PH and 30 healthy controls.
- Inflammatory markers including hsCRP, complete blood count differentials (neutrophils, monocytes, lymphocytes), and interleukin-18 were analyzed.
- Multivariate analysis and ROC analysis were employed to determine relationships between BPV indices and inflammatory markers.
Main Results:
- Children with PH showed significantly higher levels of hsCRP, neutrophils, monocytes, platelets, and lower monocyte-to-neutrophil ratio (MNR) compared to controls.
- Increased BPV indices, including 24-h ABPM SBP SD and 24-h WSBPV, were observed in the PH group.
- Inflammatory markers correlated with BPV indices; MNR predicted MAP SD, RPI, and WDBPV, while monocyte count and hsCRP also showed predictive value.
Conclusions:
- Blood pressure variability is significantly elevated in children with primary hypertension and is associated with low-grade inflammation.
- The monocyte-to-neutrophil ratio (MNR) may serve as a key indicator of BPV in pediatric hypertension.
- A high lymphocyte count is a significant predictor of non-dipping status in children with PH.
Abstract:
Background/Objectives: Increased blood pressure variability (BPV) was found in adults with primary (essential) hypertension (PH) and is associated with increased cardiovascular risk. Our study aimed to analyze the relation between BPV and low-grade inflammation in children with primary hypertension. Methods: In 56 treatment-naive pediatric patients with PH (15.1 ± 2.1 years) and 30 healthy children (14.9 ± 1.4 years), we evaluated BPV: BP dipping, standard deviation (SD) of ambulatory blood pressure measurements (ABPMs), pulse pressure (PP)/systolic blood pressure ratio (24 h PP/SBP), rate-pressure index (24 h RPI), 24-h weighted BPV (24 h WSBPV, 24 h WDBV, 24 h WMAPV), coefficient of variation (24 h CoVSBP, 24 h CoVDBP, 24 h CoVMAP), ambulatory arterial stiffness index (AASI), and morning BP surge. We also analyzed indices of subclinical inflammation (markers derived from complete blood count, high-sensitivity C-reactive protein (CRP), interleukin 18), and office and ambulatory BP. Results: Patients with PH had significantly higher hsCRP, neutrophils, monocytes, and platelets, neutrophil-to-lymphocyte (NLR), platelet-to-mean platelet volume (PMPVR), and lower monocyte-to-neutrophil (MNR) ratios, and higher BPV: 24 h ABPM SBP SD, 24 h ABPM MAP SD, 24 h RPI, 24 h WSBPV, 24 h WDBV, 24 h WMAPV, and 24 h CoVSBP. Low-grade inflammation markers correlated with BPV indices in both groups. In multivariate analysis, MNR predicted 24 h ABPM MAP SD (beta = 0.290, 95CI: 0.029-0.551), 24 h RPI (beta = -0.348, 95CI: -0.587--0.108), and 24 h WDBPV (beta = 0.286, 95CI: 0.032-0.540); monocyte count-24 h RPI (beta = 0.281, 95CI: 0.041-0.521), and hsCRP-24 h WDBV (beta = 0.310, 95CI: 0.055-0.564). ROC analysis revealed a good diagnostic profile for lymphocyte count as a positive determinant of non-dipping status in PH children (cut-off point 2.59 [×103/µL]). Conclusions: BPV is higher in children with PH compared to healthy peers and is associated with low-grade inflammation. MNR may be the most helpful indicator of BPV, whereas high lymphocyte count predicts the best non-dipping status in these patients.
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