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Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential
S R Daniels1, J M Loggie, P Khoury
1Division of Cardiology, University of Cincinnati College of Medicine and Children's Hospital Medical Center, Ohio 45229, USA.
Insights
Severe left ventricular (LV) hypertrophy and abnormal LV geometry are common in children with essential hypertension, indicating a potential risk for future cardiovascular disease.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Disease Risk Factors
- Hypertension in Youth
Background:
- Left ventricular (LV) hypertrophy is a known cardiovascular disease risk factor in adults.
- Established cutpoints for LV mass index (51 g/m(2.7)) and specific LV geometric patterns identify increased risk.
- Essential hypertension in children and adolescents requires evaluation for cardiac structural changes.
Purpose of the Study:
- To assess the prevalence of severe LV hypertrophy.
- To evaluate LV geometry in pediatric patients with essential hypertension.
Main Methods:
- Cross-sectional study of 130 children and adolescents with persistent hypertension (BP > 90th percentile).
- Measured LV mass index and assessed LV geometry.
- Analyzed risk factors associated with severe LV hypertrophy and abnormal geometry.
Main Results:
- 14% of patients exhibited LV mass above the 99th percentile; 11 of these exceeded the adult risk cutpoint.
- 17% of patients had concentric LV hypertrophy, a pattern linked to adult cardiovascular risk.
- Higher body mass index and lower heart rate at maximum exercise were associated with increased risk of severe LV hypertrophy.
Conclusions:
- Severe LV hypertrophy and abnormal LV geometry are prevalent in pediatric essential hypertension.
- These findings suggest increased future cardiovascular disease risk in affected youth.
- Early recognition and management of hypertension, including weight loss for overweight patients, are crucial.
Background:
Left ventricular (LV) hypertrophy has been established as an independent risk factor for cardiovascular disease in adults. Recent research has refined this relationship by determining a cutpoint of 51 g/m(2.7) for LV mass index indicative of increased risk and defining LV geometric patterns that are associated with increased risk. The purpose of this study was to evaluate severe LV hypertrophy and LV geometry in children and adolescents with essential hypertension.
Methods And Results:
A cross-sectional study of young patients (n=130) with persistent blood pressure elevation above the 90th percentile was conducted. Nineteen patients (14%) had LV mass greater than the 99th percentile; 11 of these were also above the adult cutpoint of 51 g/m(2.7). Males, subjects with greater body mass index, and those who had lower heart rate at maximum exercise were at significantly (P<.05) higher risk of severe LV hypertrophy. In addition, 22 patients (17%) had concentric LV hypertrophy, a geometric pattern that is associated with increased risk of cardiovascular disease in adults. Seven patients had LV mass index above the cutpoint and concentric hypertrophy. No consistent significant determinants of LV geometry were identified in these children and adolescents with hypertension.
Conclusions:
Severe LV hypertrophy and abnormal LV geometry are relatively prevalent in young patients with essential hypertension. These findings suggest that these patients may be at risk for future cardiovascular disease and underscore the importance of recognition and treatment of blood pressure elevation in children and adolescents. Weight loss is an important component of therapy in young patients with essential hypertension who are overweight.