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Relations of left ventricular geometry and function to body composition in children with high casual blood pressure
G de Simone1, G F Mureddu, R Greco
1Nutrition Unit, Federico II University Hospital School of Medicine, Naples, Italy. simogi@unina.it
Insights
High casual blood pressure in children is linked to left ventricular abnormalities, mirroring adult hypertension. This study highlights the importance of early detection and intervention for cardiovascular health in pediatric populations.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Health
- Hypertension Research
Background:
- Abnormal casual blood pressure (BP) in children may indicate underlying cardiovascular changes.
- Left ventricular (LV) abnormalities are common in adult hypertension.
- Early detection of cardiovascular risks in children is crucial for long-term health.
Purpose of the Study:
- To investigate the association between abnormal casual blood pressure (BP) and left ventricular (LV) abnormalities in children aged 6-11 years.
- To compare LV geometric and functional parameters in children with and without high casual BP.
- To assess the impact of obesity on BP and LV parameters in this pediatric cohort.
Main Methods:
- A cohort of 190 children (6-11 years) was assessed using limited echocardiography and bioelectric impedance for fat-free body mass (FFM).
- Single-visit casual BP measurements were taken, and children were categorized based on Italian BP tables.
- LV mass, relative wall thickness, and myocardial shortening (endocardial and midwall) were analyzed in relation to BP and body composition.
Main Results:
- Children with high casual BP exhibited increased LV mass, elevated relative wall thickness, and a higher prevalence of LV hypertrophy (21% vs. 4.3%).
- The risk of LV hypertrophy was 5.5-fold higher in children with high casual BP, independent of obesity, age, or sex.
- Endocardial shortening was slightly increased in children with high casual BP, while midwall shortening remained normal, suggesting preserved subendocardial function.
Conclusions:
- Casual detection of high blood pressure in school-aged children is associated with left ventricular geometric abnormalities akin to sustained hypertension in adults.
- Endocardial chamber function in children with high casual BP appears supranormal, similar to adult hypertensive responses.
- Unlike adults, midwall shortening remains normal in children with high casual BP, indicating potential differences in myocardial adaptation to elevated BP during development.
Abstract:
To determine whether abnormal casual blood pressure (BP) is associated with left ventricular (LV) abnormalities in children, 190 6- to 11-year-old children (77 girls, 113 boys) were studied at a school site in Naples, Italy, by limited echocardiography and bioelectric impedance to calculate fat-free body mass (FFM). Single-visit BP measurements (defined as casual BP) were high (based on the Italian tables of BP) in 34 children (18%; 9 girls, 25 boys; 133+/-8/81+/-10 mm Hg) and obesity was present in 44 (23%; 15 girls, 29 boys). Sex- and age-independent risk of high casual BP value was 2.9-fold (odds ratio) greater in obese than in normal-weight children (95% confidence interval, 1.3 to 6.5; P<.01). LV mass (as both absolute value and normalized for height or FFM) was higher and relative wall thickness increased in children with high casual BP (all P<.01). Prevalence of LV hypertrophy was 21% among children with high casual BP (P<.004 versus 4.3% in normal group). Risk of LV hypertrophy was 5.5-fold higher in the presence of high casual BP (P<.004), whereas obesity, age, and sex did not have independent effects. Endocardial shortening was slightly higher in children with high casual BP (36.8+/-8.2%) than in children with normal BP (34.3+/-4.8%, P<.02), whereas midwall shortening was identical in the two groups (20%). Both endocardial shortening and midwall shortening were negatively related to end-systolic stress (r=-.62, SEE=3.8% and r=-.32, SEE=2.4% in normal children). Shortening as a percentage of predicted from wall stress was increased in children with high casual BP at the endocardial level (P<.001), whereas it was normal at the midwall. Therefore, (1) casual detection of high BP in school children is associated with LV geometric abnormalities similar to those found in adults with sustained hypertension (LV hypertrophy, concentric pattern); (2) similar to in adult hypertension, endocardial chamber function in children is supranormal; and (3) in contrast to findings in adults, midwall shortening is normal in children with high casual BP.