LIPID INDICES, ARTERIAL DAMAGE AND ALBUMINURIA IN PEDIATRIC PATIENTS WITH UNTREATED PRIMARY HYPERTENSION

Abstract

Objective: Adult data proved that dyslipidemia is associated with cardiovascular risk. Our study aimed to analyze the relation between lipid indices, arterial damage and urinary albumin excretion (UAE) in children with primary hypertension (PH). Design and method: In 87 pediatric patients (15.10 ± 2.68 years, 60 boys, 27 girls) with untreated PH, we nalysed total, high-density, and low-density lipoprotein cholesterol (T-C, LDL-C, HDL-C), triglycerides (TG), and lipid indices: TG/HDL-C, Non-HDL-C, T-C/HDL-C, LDL-C/HDL-C, atherogenic index of plasma (AIP), atherogenic index (AI), lipoprotein combine index (LCI), and CHOLIndex (LDL-C - HDL-C). Additionally, we assessed 24 h ABPM, central and peripheral office BP, and arterial damage: aortic PWV, AIx75HR, cIMT, carotid arterial stiffness estimated by ultrasonic wall tracking (E-tracking - ET) and UAE [mg/24 h]. Lipid reference values were taken from the American Academy of Paediatrics 2011 Guidelines. Results: In the study group, borderline/high T-C was found in 22 (25.3%), LDL-C in 10 (11.5%), TG in 45 (51.7%), and borderline/low HDL-C in 28 (32.2%) patients; overall, 60 (69.0%) patients had dyslipidemia. Children with borderline/high LDL-C had significantly higher aPWV (5.83 ± 1.78 vs. 5.26 ± 0.78 [m/s], p = 0.047) and UAE (16 [8–122] vs. 8 [5–22] [mg/24], p = 0.034) compared to patients with normal LDL-C. In 87 studied children, UAE correlated with T-C and LDL-C (R = 0.269, p = 0.017; R = 0.245, p = 0.030) and AIx75HR with T-C (R = 0.228, p = 0.035). Also, ET augmentation index (ET AIx) correlated with HDL-C, T-C/HDL-C and AI (R = -0.245, p = 0.023; R = 0.233, p = 0.031; R = 0.233, p = 0.031), and maximal diameter of common carotid artery (D_max) with HDL-C, TG/HDL-C, T-C/HDL-C, LDL-C/HDL-C, AIP, and AI (R = -0.332, p = 0.002; R = 0.220, p = 0.042; R = 0.255, p = 0.018; R = 0.223, p = 0.039; R = 0.220, p = 0.042; R = 0.255; p = 0.018). Logistic regression revealed that the rise in CHOLIndex increased risk of elevated (>30 mg/24 h) UAE (OR: 1.035 95CI: 1.008–1.070). Conclusions: 1. Lipid disturbances are common in pediatric patients with PH 2. Elevated lipid indices are associated with common carotid artery diameter and stiffness in hypertensive children and adolescents. 3. Pediatric patients with PH and abnormal LDL cholesterol are at risk of increased aortic stiffness. 4. CHOLIndex may serve as a marker of risk of hypertensive nephropathy in pediatric patients with PH.