VASCULAR AGE IN ADOLESCENTS WITH PRIMARY HYPERTENSION

Abstract

Objective: There is evidence that children with primary hypertension (PH) are more mature than their normotensive peers in terms of bone and the immune system age. The aim of our study was to evaluate vascular age and its relationship with hypertension-mediated organ damage (HMOD) in adolescents with PH. Design and method: We assessed 362 children [90 girls; 15.5 (13.9;16.8) years] referred for work-up of office hypertension and 64 normotensive (NT) subjects [12 girls; 14.5 (13.8;15.6) years] not different in terms of age, body mass (BM) and BMI. We analyzed age- and height-related pulse wave velocity (PWV); the expected vascular age (based on measured PWV) was obtained from pooled pediatric and adult PWV norms and the difference (VascAgeDiff) between the vascular and chronological age was calculated. In all patients we obtained ambulatory blood pressure monitoring (ABPM) and HMOD: left ventricular mass index (LVMi), carotid intima-media thickness (cIMT) and pulse wave analysis (PWA) parameters: stroke volume (SV), cardiac output (CO), aortic BP (AoBP), total peripheral resistance (TPR). Results: Based on office, ABPM and AoBP, patients were classified into white coat hypertension (WCH) - 166 patients, ambulatory prehypertension (AmbPreHT) – 32; spurious hypertension (sHT – isolated systolic hypertension and normal AoBP) – 55; true hypertension (tHT – elevated office, ambulatory and AoBP) – 99. VascAgeDiff progressively increased from NT through sHT, WCH, AmbPreHT to tHT (3.5; 6.2; 7.2; 10.0; 10.7 years; p < 0.01). VascAgeDiff correlated (univariate analysis) significantly with weight, BMI z-score, office systolic (SBP) and diastolic blood pressure (DBP), AoBP, 24-h mean arterial pressure, 24-h DBP, CO, serum uric acid and LDL cholesterol level (p < 0.05). Multivariate regression analysis including above mentioned parameters revealed that significant predictors of VascAgeDiff were: weight, SBP, DBP, AoBP, CO and serum LDL cholesterol (p < 0.05). Conclusions: Out study suggests early vascular aging in adolescents with PH, even at mildly increased BP levels (WCH, prehypertension). Vascular changes were associated with increased weight, DBP, AoBP, CO and LDL cholesterol.