The cardiovascular phenotype of childhood hypertension: a cardiac magnetic resonance study

Mun H Cheang,Mun H Cheang,Michael A Quail,Michael A Quail,Kjell Tullus,Kjell Tullus,Daljit Hothi,Daljit Hothi,Gregorz T Kowalik,Vivek Muthurangu,Vivek Muthurangu,Jennifer A Steeden,Jennifer A Steeden

doi:10.1007/s00247-019-04393-6

Mun H Cheang, Mun H Cheang + Show 11 more

Open Access

https://doi.org/10.1007/s00247-019-04393-6

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Abstract

BackgroundThe cardiovascular phenotype is poorly characterized in treated pediatric hypertension. Cardiovascular magnetic resonance imaging (MRI) can be used to better characterize both cardiac and vascular phenotype in children with hypertension.ObjectiveTo use MRI to determine the cardiac and vascular phenotypes of different forms of treated hypertension and compare the results with those of healthy children.Materials and methodsSixty children (15 with chronic renal disease with hypertension, 15 with renovascular hypertension, 15 with essential hypertension and 15 healthy subjects) underwent MRI with noninvasive blood pressure measurements. Cardiovascular parameters measured include systemic vascular resistance, total arterial compliance, left ventricular mass and volumetric data, ejection fraction and myocardial velocity. Between-group comparisons were used to investigate differences in the hypertension types.ResultsRenal hypertension was associated with elevated vascular resistance (P≤0.007) and normal arterial compliance. Conversely, children with essential hypertension had normal resistance but increased compliance (P=0.001). Renovascular hypertension was associated with both increased resistance and compliance (P≤0.03). There was no difference in ventricular volumes, mass or cardiac output between groups. Children with renal hypertension also had lower systolic and diastolic myocardial velocities.ConclusionCardiovascular MRI may identify distinct vascular and cardiac phenotypes in different forms of treated childhood hypertension. Future studies are needed to investigate how this may inform further optimisation of blood pressure treatment in different types of hypertension.

Highlights

Pediatric hypertension is a rare but serious condition, with a prevalence of approximately 3–6% [1, 2]
The renal cohort consisted of pre-dialysis patients in chronic kidney disease stages 2–4 (Stage 2: 5 children, Stage 3: 7 children, Stage 4: 3 children) with stable renal function
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Summary

Introduction

Pediatric hypertension is a rare but serious condition, with a prevalence of approximately 3–6% [1, 2]. Elevated blood pressure is a common feature, it is unclear which components of vascular function (resistance, compliance or cardiac output) are abnormal in each condition. This is because comprehensive vascular phenotyping is difficult to perform using conventional noninvasive techniques. Cardiovascular magnetic resonance imaging (MRI) has been combined with noninvasive pressure measurements to accurately evaluate vascular function in children. Using this technique, it has been shown that children with renal disease have raised systemic vascular resistance compared to healthy children [5]. Cardiovascular magnetic resonance imaging (MRI) can be used to better characterize both cardiac and vascular phenotype in children with hypertension

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