Normotensive Children Research Articles

Pulse wave velocity and augmentation index, but not intima‐media thickness, are early indicators of vascular damage in hypercholesterolemic children

Arterial stiffness is an important determinant of cardiovascular risk. It is associated with several cardiovascular risk factors, including hypertension, diabetes and cigarette smoking. However, there are conflicting data about the relationship between arterial stiffness and hypercholesterolemia. Furthermore, augmentation index (AIx), a measure of systemic arterial stiffness, has not been previously investigated in hypercholesterolemic (HCh) children. Aim of our study was to evaluate local and systemic arterial stiffness as well as carotid intima-media thickness (IMT) in HCh children and also to investigate the relation between serum cholesterol levels and arterial stiffness. We determined lipid profile, body mass index, blood pressure, heart rate, carotid IMT and several arterial stiffness parameters, as beta-index, elastic modulus (E(p)), arterial compliance (AC), pulse wave velocity (PWV) and AIx, in 44 untreated HCh children (mean age 10.7 +/- 2.8 years; 18 with familial hypercholesterolemia, FH, and 26 with primary hypercholesterolemia, PHC) and 18 age- and sex-matched controls. HCh children never received any medication, including antihypertensive and lipid lowering drugs. Respect to controls and to PHC, FH had significantly higher (P < 0.001) beta-index (5.22 +/- 1.13 vs. 3.13 +/- 0.74 and 3.60 +/- 1.02), PWV (4.72 +/- 0.72 m s(-1) vs. 3.66 +/- 0.55 m s(-1) and 4.10 +/- 0.67 m s(-1)), AIx (3.55 +/- 3.97% vs. -4.43 +/- 4.09% and 0.61 +/- 2.39%) and E(p) (64.4 +/- 19.6 kPa vs. 36.2 +/- 11.3 kPa and 42.9 +/- 13.1), whereas AC (1.25 +/- 0.48 mm(2) kPa(-1) vs. 1.9 +/- 0.43 mm(2) kPa(-1) and 1.62 +/- 0.43 mm(2) kPa(-1)) was lower (P < 0.001). There was no significant difference in carotid IMT and blood pressure values between the groups. The multiple regression analysis showed a significant association of arterial stiffness values with plasma cholesterol levels (P < 0.0001). Our findings show that local and systemic arterial stiffness are increased in asymptomatic, normotensive HCh children, suggesting that HCh plays a key role in arterial mechanical impairment since the paediatric age.

Myocardial performance after successful intervention for native aortic coarctation

Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.

Angiotensin‐converting enzyme gene insertion/deletion polymorphism frequency in normotensive children with a positive family history of essential hypertension

To evaluate the possible relationship between blood pressure (BP) and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism in normotensive children with a positive family history of essential hypertension (EHT). Three hundred seventy-six randomly selected normotensive schoolchildren (147 boys, 229 girls) between the ages of seven and 17 years were enrolled. Children were subdivided into a 'first-degree relative group' and a 'second-degree relative group' according to the presence of EHT in parents or grandparents, respectively. BP was measured twice from the right arm and the systolic BP, diastolic BP and mean BP were recorded. ACE gene I/D polymorphism was performed from all studied children and frequency od DD, ID and ID allele were analysed in each study group. Allelic frequencies of the DD genotype of the ACE gene were higher in children with a positive history in the first- (36.2%) and second-degree (38.3%) relatives for EHT than the controls (30.7%) (P < 0.05 for both). Children with a positive family history of EHT and a DD genotype, had significantly higher SBP, DBP and MBP levels (P < 0.05) than the children with ID or II genotypes. We found that the ACE gene DD genotype was common and that BP levels were higher in Turkish children with a positive family history of EHT and DD genotype. Because the presence of DD allele might be the one of the potential contributor of EHT pathogenesis, further studies needed in large cohort for long term follow-up for EHT in children with DD allele.

Synchronization of adolescent blood pressure and pubertal somatic growth.

Blood pressure (BP) and growth increase at an accelerated rate during puberty. The temporal relationship of the two events has not been well characterized. The purpose of this current investigation was to examine the rate of BP change in relation to pubertal growth with the intent to shed light on new mechanisms by which BP is regulated. We examined data from a cohort of 182 normotensive children who had measurements made semiannually for up to 12 yr. From the recorded heights, we identified the subject-specific pubertal growth spurt (PGS) using a growth curve model. With the estimated PGS as an anchoring point, we obtained the rates at which BP and weight changed as continuous functions of time for the duration of pubertal growth. Examining BP on a scale relative to PGS placed BP development in the context of pubertal growth. Average ages at PGS were 11.5 for girls and 13.3 for boys. Fitted spline models estimated that at the time of PGS, the mean systolic BP was 100 mm Hg for girls and 107 mm Hg for boys; the mean diastolic BP at the PGS was 59 mm Hg for girls and 61 mm Hg for boys. The most intriguing observation was that rate of change in systolic BP and weight peaked at precisely the estimated PGS. The time synchronization of rates of change in BP, weight, and height suggests common regulating mechanisms for somatic growth and BP or growth changes that secondarily affect BP.

Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents

The purpose of this study was to investigate differences in left ventricular mass index (LVMI) and the prevalence of left ventricular hypertrophy (LVH) in children and adolescents classified as normotensives, prehypertensives and hypertensives by ambulatory blood pressure (BP) levels. A total of 124 consecutive children and adolescents aged 5 to 18 years were analysed. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography. Hypertensive and prehypertensive subjects had significantly higher LVMI than normotensives (36.8 +/- 8.4 g/m(2.7) and 34.1 +/- 3.4 g/m(2.7) vs. 29.5 +/- 8.3 g/m(2.7), P < 0.01 and P < 0.05, respectively). In multivariate analysis predictors for LVMI were body mass index (BMI) z score and hypertension (R-squared = 0.31). LVMI values in hypertensive subjects were significantly higher than those of normotensives even after adjustment for age, sex and BMI z score. The prevalence of LVH was significantly higher in the prehypertensive compared to normotensive subjects, and was equal to that of the hypertensive subjects. Hypertension and prehypertension in children and adolescents were associated with pathologically elevated LVMI values. If confirmed in a larger group prehypertensive children may be at risk for target organ damage similar to the condition of established hypertension.

Life‐threatening hypokalemia in an infant (Discussion and Diagnosis)

The Case Presentation can be found on page 1234. DISCUSSION Severe hypokalemia is an unusual metabolic abnormality in children. Apart from a detailed clinical history and meticulous physical examination central to the diagnostic approach of a child with hypokalemia is the evaluation of the concurrent acid ⁄base status, the presence or absence of hypertension and of increased or normal urine potassium. In the presence of normal blood pressure and without urinary potassium losses, extrarenal causes of hypokalemia should be investigated. If hypokalemia is associated with hypertension, Cushing’s syndrome, renovascular diseases or causes of excess renin and mineralocorticoids should be sought (1,2). In infants, the combination of hypertension and hypokalemia is particularly suggestive of congenital adrenal hyperplasia due to CYP11B1 (11b-hydroxylase) deficiency (3). The lack of hypertension in our patient in addition to the normal values of serum 11-deoxycortisol, 11-deoxycorticosterone, dehydroepiandrosterone, dehydroepiandrosterone sulphate, androstenedione and testosterone ruled out congenital adrenal hyperplasia due to 11b-hydroxylase deficiency. In normotensive children, like our patient, the most common causes of hypokalemia include pyloric stenosis, protracted diarrhoea, skin losses and potassium-losing tubulopathies, such as Bartter and Gitelman syndromes (4). In children with compatible personal history, diuretics, amphotericin B and laxative abuse should also be considered in the differential diagnosis of hypokalemia. In the infant presented, pyloric stenosis and protracted diarrhoea were initially considered as the cause of severe hypokalemia with associated low urine potassium, but the history was not consistent with gastrointestinal losses, since the infant had mild non-projectile vomiting for 2 days only, without any associated diarrhoea. Bartter andGitelman syndromes were initially included in the differential diagnosis, but were unlikely by the lack of frank metabolic alkalosis, the consistently low urine potassium on several measurements and the lack of hypomagnesemia, a consistent feature of Gitelman syndrome and a frequent feature of Bartter syndrome type III (4–6). The negative history, the normal serum glucose and the nonconsistent history alsomade other extrarenal causes of hypokalemia, such as the use of insulin and of b2-agonists, highly unlikely. Absence of concurrent hypochloremia and metabolic alkalosis and the high serum chloride minimized the possibility of cystic fibrosis and congenital chloridorrhea (7). Finally, the low urine potassium along with the arterial pH of 7.45 excluded type I distal renal tubular acidosis, a condition that can be associated with hypokalemia in the context of metabolic acidosis due to defective urine acid secretion (8). When the dietary intake of potassium is reduced, depletion of potassiumandhypokalemia result because the renal excretionof thiscation fails todecreasepromptly.Eventually,when hypokalemia is established, renal potassium excretion is minimized, like in our patient, who at presentation had both severehypokalemiaandminimalurinepotassiumlosses. When severe, hypokalemia can induce rhabdomyolysis, but this was not seen in our patient who had a normal serum CPK (9). After meticulous history taking with emphasis on dietary intake, the mother admitted that the infant was exclusively fed with a mixture of water, flour and butter for at least 15 days due to his refusal to take the formula. Apparently, this is not an uncommon practice for infants with intolerance to breast milk or formula in rural areas of Bulgaria, the home Acta Paediatrica ISSN 0803–5253

Baroreflex sensitivity is reduced in obese normotensive children and adolescents

Obesity is associated with autonomic nervous system dysfunction. The aim of the study was to evaluate baroreflex sensitivity, an indicator of autonomic nervous function, in 20 obese children and adolescents in comparison with 20 age- and sex-matched nonobese subjects. All subjects were examined in the supine position over a period of 50 min. Systolic blood pressure (SBP) and RR intervals were monitored continuously. Baroreflex sensitivity was assessed by cross-spectral analysis of SBP and RR interval oscillations (BRS index) and SBP and heart rate oscillations (BRSf index) within the low frequency range (0.04-0.15 Hz). Sensitivity was determined in 3 time intervals of 3 min each to evaluate changes during rest. The BRS index was significantly lower in obese children and adolescents than in the nonobese control group (p = 0.002). Significant changes in the BRS index over time (p = 0.004) were found only in nonobese subjects. In contrast, the BRSf index increased over time in both groups (p = 0.01), and no significant between-group difference was detected. In conclusion, obese children and adolescents show decreased resting baroreflex sensitivity with less variation compared with nonobese subjects. The BRS and BRSf indices appear to be only partially correlated.

Assessment of matrix metalloproteinase (MMP)-2, MMP-8, MMP-9, and their inhibitors, the tissue inhibitors of metalloproteinase (TIMP)-1 and TIMP-2 in obese children and adolescents

Objectives To compare the circulating levels of matrix metalloproteinase (MMP)-8, pro-MMP-2, pro-MMP-9, and total MMP-9, their endogenous inhibitors, the tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2, and the MMP-8/TIMP-1, MMP-9/TIMP-1, and MMP-2/TIMP-2 ratios in normotensive obese children and adolescents with those found in non obese children and adolescents. Design and methods We studied 40 obese and 40 non obese (controls) children and adolescents in this cross-sectional study. MMP and TIMP concentrations were measured in plasma samples by gelatin zymography and ELISA. Results Obese children and adolescents had higher circulating MMP-8 concentrations, lower plasma TIMP-1 concentrations, and higher MMP-8/TIMP-1 ratios than non obese controls ( P < 0.05). We found no differences in pro-MMP-9 or total MMP-9 levels, or in MMP-9/TIMP-1 ratios between groups ( P > 0.05). While we found no significant differences in pro-MMP-2 levels ( P > 0.05) obese subjects had higher TIMP-2 concentrations and lower pro-MMP-2/TIMP-2 ratios ( P < 0.05) than non obese controls. Conclusions In conclusion, we found evidence indicating higher net MMP-8 (but not MMP-9 and MMP-2) activity in childhood obesity. The increased MMP-8 levels found in obese children suggest a possibly relevant pathophysiological mechanism that may be involved in the increase of cardiovascular risk associated with childhood obesity.

Notice of release of La Salle germplasm Arizona cottontop selected class of natural germplasm

ABSTRACT. Hypertension frequently complicates the course of chronic renal insufficiency (CRI) in children. This study sought to define the role of hypertension in progression of CRI in children by using the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) CRI database. The study cohort consisted of 3834 patients aged 2 to 17 yr with an estimated GFR (eGFR) ≤75 ml/min·1.73 m² enrolled onto NAPRTCS. The time to end point was defined as the time between registry enrollment and progression to renal substitution therapy or a 10 ml/min·1.73 m² drop in GFR from baseline, whichever was first. Forty-eight percent of the study patients had hypertension at baseline. There was a significant difference in reaching end points between hypertensive and normotensive children (58% <i>versus</i> 49%, respectively, <i>P</i> &lt; 0.001). Significant difference in outcome between hypertensive and nonhypertensive patients was seen in children with eGFR 50 to 75 ml/min·1.73 m² (<i>P</i> &lt; 0.001). Multivariate Cox regression modeling demonstrated that systolic hypertension was a significant independent predictor of progression of CRI (<i>P</i> = 0.003). Other significant predictors of CRI progression in this model included older age (<i>P</i> = 0.0001), African American ethnicity (<i>P</i> = 0.03), acquired cause of renal disease (<i>P</i> = 0.0001), and baseline eGFR &lt;50 ml/min·1.73 m² (<i>P</i> = 0.0001). Hypertension is a highly significant and independent predictor for progression of CRI in children. E-mail: Mark.Mitsnefes@cchmc.org

Prospective Change in Renal Volume and Function in Children with ADPKD

Autosomal dominant polycystic kidney disease (ADPKD) is a progressive hereditary disorder affecting children and young adults. Early intervention may be necessary to significantly affect the long-term consequences of this disease. The authors conducted a 5-yr randomized clinical trial to assess the effect of BP control with angiotensin-converting enzyme inhibition (ACEI) on disease progression in 85 children and young adults with ADPKD. Study groups were determined by subject BP, including hypertension (BP >or= 95th percentile), borderline hypertension (BP 75 to 95th percentile), and severe ADPKD (BP <or=75th percentile with > 10 renal cysts). The primary outcome variable was renal volume by ultrasound, with secondary outcome variables including left ventricular mass index (LVMI) and microalbuminuria. In secondary analysis, the authors compared results between hypertensive and normotensive groups. The authors were not able to demonstrate a significant effect of ACEI on renal growth in young subjects with ADPKD. Hypertensive children were at particular risk for increases in renal volume and LVMI and decreased renal function as compared with the other study groups, and borderline hypertensive children were at high risk to develop hypertension over time. However, ACEI treatment was associated with stable renal function and LVMI in this group of children. Close monitoring of cardiovascular and renal status is indicated in ADPKD children with hypertension or borderline hypertension. In contrast to effects in hypertensive ADPKD children, ACEI treatment in normotensive or borderline hypertensive ADPKD children may prevent the development of increased LVMI and deterioration in renal function.

Letter by Bocelli et al Regarding Article, “A Novel Method of Expressing Left Ventricular Mass Relative to Body Size in Children”

To the Editor: In the recent interesting article by Foster et al,1 the standard method of indexing left ventricular (LV) mass to height2.7 was found to be inadequate to adjust for body size in a reference population that included healthy individuals from birth to 21 years of age. In particular, LV mass index (LVMI) was relatively independent of height in taller subjects but showed a strong residual correlation with height in subjects <100 cm tall, ie, in newborns, infants, and children in their first years of life. In contrast, a more complex method based on percentile curves provided adequate normalization to body size, with …

Pilot safety study of low-dose vasopressin in non-septic critically ill children

To assess the safety of low-dose vasopressin infusion in critically ill children requiring prolonged mechanical ventilation (MV) at risk of developing sedation/analgesia-related hypotension. Randomized pilot safety study in children expected to require MV for at least 3 days. Children received either vasopressin (0.0005 U/kg/min) or sodium chloride (0.9%) infusion for a period of 48 h. Haemodynamic variables, urine output and serum electrolytes were closely monitored and analyzed. Twelve children in each group had similar baseline characteristics. Vasopressin infusion was associated with an 8 mmol/L fall in serum sodium concentration (p < 0.01) and with higher incidence of hyponatraemia (8 vs. 66%, p < 0.01). In normotensive children, low-dose vasopressin also induced a reversible decrease in urine output, and acutely increased blood pressure (p < 0.01). After stopping the vasopressin there was rebound hypotension (p < 0.01). Low-dose vasopressin infusion in haemodynamically stable, but critically ill, children is associated with reduction in urine output and decreased serum sodium level, yielding a high incidence of hyponatraemia. We conclude that these effects limit further study of prophylactic vasopressin for sedation-related hypotension in a randomized controlled trial.

Predictors of Higher Blood Pressure in a Clinical Setting in Normotensive Children: A Prospective Study

This study was designed to assess the predictors of a higher blood pressure (BP) in a clinical setting in a prospective cohort of normotensive children recruited in an outpatient pediatric clinical setting in Southern Brazil. The study evaluated 443 children 3–12 years of age. If the mean value of BP was greater than the 95th percentile for age, sex and height in the medical setting, children were scheduled to other two evaluations at home. The systolic BP percentile in the clinical consultation was associated with BMI and birth weight. The diastolic BP in the clinical consultation was associated with birth weight, age, and BMI. Weight excess, low birth weight and younger age were associated with a higher BP in normotensive children seen in a clinical setting. To our knowledge, this is the first study to describe the association between lower birth weight and a greater BP response to medical consultation. Our finding suggests that the tendency to higher white-coat effect is determined, at least to some extent, in intrauterine life.

Increased left ventricular mass in children with autosomal dominant polycystic kidney disease and borderline hypertension

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary condition that may be diagnosed in utero. Our goal was to evaluate symptoms of ADPKD in children, including left ventricular mass index (LVMI), renal volume, renal function and microalbuminuria in relation to systolic and diastolic blood pressure. Eighty-five children were stratified by blood pressure into three cohorts: hypertensive (95th percentile and over), borderline hypertensive (75-95th percentile) and normotensive (75th percentile and below). There were no differences in gender, age, height, renal function, or microalbuminuria between the groups. Both the hypertensive and borderline hypertensive children had a significantly higher LVMI than normotensive children, with no significant difference between hypertensive and borderline hypertensive groups. There was a significant correlation between renal volume and both systolic and diastolic blood pressures in all subjects. Renal volume in hypertensive children was significantly larger than in the borderline hypertensive group, with no significant difference between normotensive and borderline hypertensive groups. These findings show that an increase in LVMI may be detected earlier than an increase in renal volume in children with ADPKD and borderline hypertension, suggesting that close monitoring of cardiac status is indicated in these children.

Ambulatory Arterial Stiffness Index Is Increased in Hypertensive Childhood Disease

Arterial hypertension in adults is often associated with an increased arterial stiffness, which correlates with the ambulatory arterial stiffness index (AASI) as derived from ambulatory blood pressure (BP) measurements. The purpose of this study was to demonstrate whether children with diagnosed hypertension have an increased AASI as in hypertensive adults. AASI was calculated from 185 ambulatory BP measurements of 114 hypertensive and 71 normotensive, healthy children. Hypertensive children had higher AASI values compared with their normotensive healthy counterparts (0.370 +/- 0.120 versus 0.204 +/- 0.199, p < 0.0001). Children with longer duration of hypertension or a history of primary or secondary aortic coarctation displayed even more elevated AASI values. A receiver operator curve derived cut-off of AASI set at 0.301 distinguished (p < 0.0001) hypertensive from normotensive children with an odds ratio of 8.2, a sensitivity of 81%, and a specificity of 65%. Moreover, AASI correlated with pulse and systolic BP. In conclusion, AASI is elevated in hypertensive children and correlates with the duration and the origin of hypertension in childhood.

Gender differences in urinary ACE and ACE2 activities in adolescents

The renin angiotensin system (RAS) plays a vital role in the homeostasis of blood pressure, body fluid volume and electrolyte balance. As childhood obesity and metabolic disorders become epidemic, risk factors for cardiovascular disease, such as high blood pressure, ensue at earlier ages. To study the contribution of the renal RAS, we initially characterized angiotensin (Ang) metabolism in the urine collected from 12 healthy normotensive children (6 males, 6 females; 14 years old). ACE activity as determined by the hydrolysis of radiolabeled 125I‐Ang I to Ang II was greater in males than females (17.7±7.5 vs. 7.5±1.4 fmol/ml/min; P&lt;0.05). Conversion of Ang II to Ang (1–7) by ACE2 was also higher in males (16.3±2 vs. 9.3±1.5 fmol/ml/min; P&lt;0.05), while neprilysin (NEP) activity [Ang I to Ang (1–7) and Ang (1–4)] was similar between groups (11.3±3 vs. 5.1±0.2 fmol/ml/min). Immunoblot analysis with antibodies against ACE and the ACE2 ectodomain revealed a prominent band at 170 kDa and 120 kDa, respectively, in males while an 86 kDa band was evident for NEP in both groups. These data clearly demonstrate the feasibility of measuring multiple enzyme activities of the RAS in the urine of adolescents. Moreover, the significant gender difference in both ACE and ACE2 activities suggests potential alterations in the metabolism of angiotensin between sexes. Supported by HD047584–02S3, HL‐56973, M01‐RR07122.

Normality of Upper and Lower Peripheral Pulse Transit Time of Normotensive and Hypertensive Children

The ankle-brachial index (ABI) is known to be indicative of sub-clinical peripheral arterial diseases that are correlated with cardiovascular disease risk factors like atherosclerosis or ischemic extremity. Due to its occluding measurement nature, this may not be appealing to less cooperative patients when multiple prolonged screening is required. A simple and non-intrusive approach termed pulse transit time ratio (PTTR) has recently shown to be potential surrogate marker for the prolonged ABI measurement. Other studies have also suggested that subjects with hypertension have stiffer arterial wall and thereby can confound transit time related parameters. Thus, it becomes important to understand the PTTR normality and difference of hypertensive children when compared to those measured from normotensive children. About 55 normotensive (39 male; aged 8.4 +/- 2.3 yr) and 4 hypertensive (4 male; aged 5-10 yr) Caucasian children were recruited from the same geographical location. A customized device was used to compute pulse transit time related measurements. Since the PTTR approach produced a delta value that was similar to that of ABI, possible inter-subject physiologic differences had limited confounding effects on the derived PTTR parameter. The obtained transit time measurements from the hypertensive children had lower pulse transit time value when compared to their normotensive counterparts. However, the statistical analysis indicated that they had insignificant PTTR difference (p > 0.01) from those seen in the normotensive children. The findings herein suggest that stiffer arterial wall may have confounding effects on the derived transit time related measurements but it is limited on the PTTR parameter. Similar to the ABI approach, PTTR may be only confounded by abnormal local changes in either of the measured peripheral arterial wall. Hence, the PTTR technique shows promise to be an ABI marker from this perspective.

Sodium taste threshold in children and its relationship to blood pressure

Popular science has emphasized the risks of high sodium intake and many studies have confirmed that salt intake is closely related to hypertension. The present mini-review summarizes experiments about salt taste sensitivity and its relationship with blood pressure (BP) and other variables of clinical and familial relevance. Children and adolescents from control parents (N = 72) or with at least one essential hypertensive (EHT) parent (N = 51) were investigated. Maternal questionnaires on eating habits and vomiting episodes were collected. Offspring, anthropometric, BP, and salt taste sensitivity values were recorded and blood samples analyzed. Most mothers declared that they added "little salt" when cooking. Salt taste sensitivity was inversely correlated with systolic BP (SBP) in control youngsters (r = -0.33; P = 0.015). In the EHT group, SBP values were similar to control and a lower salt taste sensitivity threshold. Obese offspring of EHT parents showed higher SBP and C-reactive protein values but no differences in renin-angiotensin-aldosterone system activity. Salt taste sensitivity was correlated with SBP only in the non-obese EHT group (N = 41; r = 0.37; P = 0.02). Salt taste sensitivity was correlated with SBP in healthy, normotensive children and adolescents whose mothers reported significant vomiting during the first trimester (N = 18; r = -0.66; P < 0.005), but not in "non-vomiter offspring" (N = 54; r = -0.18; nonsignificant). There is evidence for a linkage between high blood pressure, salt intake and sensitivity, perinatal environment and obesity, with potential physiopathological implications in humans. This relationship has not been studied comprehensively using homogeneous methods and therefore more research is needed in this field.

Validation of the Omron 705 IT oscillometric device for home blood pressure measurement in children and adolescents: The Arsakion School Study

Limited evidence exists on the accuracy of oscillometric devices for blood pressure measurement in children. This study validated the Omron 705 IT monitor (Omron Healthcare Europe BV, Hoofddorp, The Netherlands) in normotensive children and adolescents. Simultaneous blood pressure measurements were taken by two observers (connected mercury sphygmomanometers) four times, sequentially with three measurements by using the tested device. Absolute device-observer blood pressure differences were classified into three zones (within 5, 10 and 15 mmHg) and assessed using the European Society of Hypertension International Protocol criteria. The number of readings with a difference within 5 mmHg was calculated for each individual. The American Association for the Advancement of Medical Instrumentation criterion (mean difference+ or -SD <5+ or -8 mmHg) was also applied. A total of 197 study participants (591 readings) were included (99 boys, mean age+ or -SD 10.6+ or -2.4 years (range 6-16 years). The device produced 378 (64%), 532 (90%) and 579 (98%) measurements within 5, 10 and 15 mmHg, respectively, for systolic blood pressure, and 415 (70%), 525 (89%) and 577 (98%) measurements, respectively, for diastolic blood pressure. In all, 136 study participants (69%) had at least two systolic blood pressure differences within 5 mmHg and 16 (8%) had no differences within 5 mmHg (for diastolic blood pressure 147 (75%) and nine (5%) participants, respectively). Mean systolic blood pressure difference was 4.0+ or -4.8 mmHg and diastolic blood pressure -2.1+ or -5.9 mmHg and was <5+ or -8 mmHg in quartiles of participants divided by age, height, body mass index, arm circumference, blood pressure or pulse rate. The Omron 705 IT appears to be an accurate device for blood pressure measurement in normotensive children and adolescents.

Effect of fosinopril in children with steroid-resistant idiopathic nephrotic syndrome

We aimed to test if fosinopril reduces urinary protein excretion and alleviates renal tubular damage in normotensive children with steroid-resistant idiopathic nephrotic syndrome (SRINS). We also aimed to evaluate whether there are changes in steady-state blood pressure and serum concentrations of serum angiotensin-converting enzyme (ACE) and plasma renin activity or angiotensin II (AT-II) in children under this treatment. Forty-five normotensive patients with SRINS were randomly divided into two groups. Group I was treated with fosinopril and prednisone for 12 weeks, while group II was treated with prednisone alone for the same duration. The values of 24-h urinary protein excretion were 1.25+/-0.64 vs 2.52+/-0.56 g/24 h (P<0.05), 1.16+/-0.45 vs 2.42+/-0.24 g/24 h (P<0.05), and 1.10+/-0.41 vs 2.05+/-0.46 g/24 h (P<0.05) in group I and group II patients, respectively, at 4, 8, and 12 weeks. Patients in group I showed lower serum concentrations of urinary retinol-binding protein and beta(2)-microglobulin (P<0.01) at the end of the study, but the patients' blood pressure and components of the renin-angiotensin system (RAS) had no change during treatment. The result suggested that fosinopril significantly reduced proteinuria and alleviated renal tubular damage, but did not influence blood pressure and components of systemic RAS in normotensive children with SRINS.