Abstract
Adults with arterial hypertension (HTN) have stroke, myocardial infarction, end-stage renal disease (ESRD), or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes “hard outcomes” observed in adults. Left ventricular hypertrophy (LVH) or an anatomic and pathologic increase in left ventricular mass (LVM) in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered “the gold standard” for LVM and LVH determination, pediatric data are limited to “special populations”: ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.
Highlights
Framingham Heart Study proved that adults with arterial hypertension (HTN) have increased mortality due to myocardial infarction and stroke compared to adults without HTN.1 These “hard outcomes” have not been clearly demonstrated in children with HTN
We summarize available data on pediatric left ventricular hypertrophy (LVH) treatment and reversibility and offer future directions in addressing LVH in children with HTN
LVH independently of blood pressure (BP) levels predicted poor prognosis in adults enrolled in the Framingham Heart Study
Summary
Framingham Heart Study proved that adults with arterial hypertension (HTN) have increased mortality due to myocardial infarction and stroke compared to adults without HTN. These “hard outcomes” have not been clearly demonstrated in children with HTN. The relative risk of cardiovascular mortality for every 50 g increment in left ventricular mass (LVM) was 1.73 in men and 2.12 in women [8] The focus of this mini review is on definition, detection, epidemiology, management, and reversibility of LVH. Widening of the LV chamber creates circulatory difficulties and presents a vicious cycle to the cardiac muscle, increasing risk for cardiovascular complications [10] Both casual office BP readings and 24-h ambulatory blood pressure monitoring (ABPM) have a direct relationship to LVM/LVH: the higher office BP, the higher average BP recorded over the course of the day and night, or the higher ABPM BP loads (prevalence of abnormal elevated BP readings) the greater possibility for LVH [11]. This in turn depends on the accuracy of LVM measurements, and LVH detection and normalization method used
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