Primary Hypertension In Children Research Articles

O107 A LONGITUDINAL STUDY ON THE IMPACT OF CHILDHOOD ELEVATED BLOOD PRESSURE ON TARGET ORGAN HEALTH IN ADOLESCENCE: THE EXAMIN YOUTH SA STUDY

Background and objective: Primary hypertension in children is becoming a global threat for the growing economic burden of hypertension management in adulthood and sustainable healthcare. We determined the associations of adolescent blood pressure (BP) with target organ damage markers (carotid intima-media thickness (CIMT) and left ventricular mass index (ilVM)) over a four year period, stratified by childhood BP status at baseline. Methods: We included 421 Black and 307 White South African adolescents (mean age: 11.04 years) with complete follow-up data for BP, CIMT and iLVM. Standard anthropometric measures and basic demographic information were collected. Results: Children were stratified by baseline BP status, i.e., normotensive; n=454 (57.5% Black and 57.7% female) and elevated BP; n=274 (58.4% Black and 52.2% female), with comparable proportions of ethnicity (p=0.81) and sex (p=0.15). Systolic BP (by 6mmHg; p<0.001), diastolic BP (by 3mmHg; p<0.001) and perfusion pressure (by 4mmHg; p<0.001) as well as sex-specific body mass index for age z-scores (BAZ; p<0.001) were all higher in the elevated BP compared to normotensive group. Groups were comparable for age (p=0.78), CIMT (p=0.28) and iLVM (p=0.64). In partial regression analysis (adjusting for ethnicity, sex, follow-up age and BAZ), systolic BP correlated positively with CIMT (r=0.125; p=0.041) and iLVM (r=0.184; p=0.002) in the elevated BP group only. Backward multiple adjusted linear regression analysis (adjustment for perfusion pressure at baseline, age, sex, ethnicity and BAZ) showed adverse associations of systolic BP with CIMT (β=0.126; p=0.046) and iLVM (β=0.199; p=0.001), and diastolic BP with iLVM (β=0.130; p=0.002), only in children with elevated BP at baseline. Conclusion: Elevated BP in early childhood contributes to the long-term impact on target organ health during adolescence independent of sex and ethnicity, while the association of BP with iLVM seems to be moderated by excess adiposity.

Preventive Cardiovascular Measures in Children with Elevated Blood Pressure.

Cardiovascular diseases are the leading cause of morbidity and mortality in developed countries and are becoming increasingly significant in developing nations. Many cardiovascular risk factors originate early in life, even prenatally. Elevated blood pressure and hypertension are gaining attention in paediatrics due to their rising prevalence and impact on early cardiovascular risk in adulthood. Along with non-modifiable risk factors for hypertension, several modifiable factors can be addressed through primordial and primary prevention, emphasising lifestyle modifications. When these measures fail and elevated blood pressure develops, early detection is crucial (secondary prevention). Regular blood pressure measurement, a simple and non-invasive procedure, should be a standard practice in paediatric clinical settings. Diagnosing elevated blood pressure and hypertension should adhere to recommended guidelines. Lifestyle modifications are the first-line therapy for primary hypertension in children; if a secondary cause is identified, targeted treatment can be implemented, but a healthy lifestyle remains essential. The early detection and treatment of high-risk blood pressure enable timely interventions to prevent complications (tertiary prevention). Collectively, these preventive measures aim to reduce the incidence of cardiovascular disease in adulthood. Furthermore, quaternary prevention seeks to avoid unnecessary or harmful medical interventions including unwarranted examinations and pharmacotherapy. This underscores the importance of accurate diagnosis and treatment of elevated blood pressure and hypertension and emphasises the need for primordial and primary prevention to minimise unnecessary clinical interventions.

Primary Hypertension in Children and Adolescents

The incidence of primary hypertension is on the rise in the pediatric population, with an approximate prevalence ranging from 3% to 5%. The most significant risk factors for the onset and development of primary hypertension are well-known, and some of them are preventable, including increased salt consumption and obesity. Connected with metabolic risk factors, elevated blood pressure in childhood is carried into adulthood. Primary hypertension is associated with attenuated vascular responses to various physiological stimuli in both peripheral microcirculation and systemic macrocirculation in adults and children. Endothelial dysfunction is one of the most important features of arterial hypertension, together with an increased level of oxidative stress – both determinants significantly contribute to all the pathophysiological changes observed in hypertension. Systemic arterial hypertension has emerged as a prevalent cardiovascular risk factor associated with substantial morbidity and mortality. Hence, the timely identification of individuals with elevated blood pressure and early-life blood pressure management could serve as a crucial strategy to mitigate the risk of cardiovascular disease and mortality in adulthood.

ASSOCIATION OF SUBCLINICAL INFLAMMATION MARKERS WITH PRIMARY HYPERTENSION IN CHILDREN - A SYSTEMATIC REVIEW WITH META-ANALYSIS

Objective: Primary hypertension (PH) is a growing threat to children's health. The pathogenesis of this phenomenon is not fully known, and subclinical inflammation and activation of the immune system are potential explanations. This systematic review and meta-analysis aimed to systematically determine whether there is an association between low–grade inflammation markers and PH in children. Design and method: The MEDLINE, EMBASE, and Cochrane databases were searched up to March 2023, with no language restrictions, for cohort, cross-sectional, and case-control studies; additional references were obtained from reviewed articles. The included studies needed to investigate an association between any inflammation markers and PH defined by the authors. Participants of the study were children (<18 years old) with PH and healthy controls. The main outcome measured was the concentration of any subclinical inflammation markers in children with PH and in healthy controls. This meta-analysis included 12 studies published between 2005 and 2022, enrolling 1220 patients (689 with PH and 531 healthy controls). The data were analyzed using Review Manager. Pooled mean difference (MD) with 95% confidence interval (95% CI) was used to assess the differences in inflammation markers levels. All analyses were based on the random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale. Results: There was a significant difference between hypertensive and control groups in high-sensitivity C-reactive protein (hsRCP) concentration (MD: 0.07 95%CI [0.04,0.09]), intercellular adhesion molecule 1 (ICAM-1) (MD: 85.28 95%CI: [50.57-119.99]), vascular cell adhesion molecule 1 (VCAM-1) (MD: 259.78 95%CI: [22.65-496.91]), neutrophil count (MD: 0.80 95%CI [0.53-1.07]), monocyte count (MD: 0.07 95%CI: [0.02-0.12]), and neutrophil-to-lymphocyte ratio (NLR) (MD: 0.49 95%CI: [0.32-0.65]). There was no difference in terms of interleukin 6 (IL-6), lymphocyte count, platelet count, mean platelet volume (MPV), as well as in platelet-to-lymphocyte (PLR) and monocyte-to-lymphocyte (MLR) ratios. Conclusions: Some easily accessible markers of low-grade inflammation might be used as an additional tool for diagnosis and screening for hypertension in pediatric patients. These promising results should be validated in large and well-conducted studies.

Clinical features and risk factors of left ventricular hypertrophy in children with primary hypertension

Objective: To assess the clinical features and relative factors of left ventricular hypertrophy (LVH) in children with primary hypertension. Methods: In this retrospective cohort study, 430 children diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics from January 2019 to September 2022 were enrolled. Their clinical data was analyzed and LVH was assessed by echocardiography. According to left ventricular geometry, these children were assigned to the LVH group and normal geometry group. General conditions, laboratory indicators and ambulatory blood pressure parameters between two groups were compared by independent sample t-test or Mann-Whitney U test. Spearman correlation coefficient was used to analyze the correlation between LVH and clinical indicators including blood pressure, biochemical and metabolic indicators. The independent risk factors of LVH were analyzed by multivariable logistic regression. The receiver operating characteristic (ROC) curve was used to explore the value of risk factors in the diagnosis of LVH. Results: Among the 430 children with primary hypertension, 342 (79.5%) were males and 88 (20.5%) females. Their age was (12.6±2.3) years, and 123 children (28.6%) of them had LVH. Body mass index (BMI) ((30.0±5.2) vs. (26.2±4.3) kg/m2), ratio of stage 2 hypertension (75.6% (93/123) vs. 59.6% (183/307)), 24-hour systolic blood pressure (24 h SBP)((131±10) vs. (128±10) mmHg,1 mmHg=0.133 kPa), daytime systolic blood pressure (SBP) ((135±11) vs. (131±11) mmHg), nighttime SBP ((128±11) vs. (123±10) mmHg), cholesterol level ((4.0±0.7) vs. (3.9±0.7) mmol/L), serum uric acid level ((447±81) vs. (426±91) μmol/L) and incidence of hyperinsulinemia (69.9% (86/123) vs.59.0% (181/307)) were significantly elevated in the LVH group compared with those in the normal geometry group (all P<0.05). There were more patients with a disease course over 5 years in the LVH group than in the normal geometry group, with a statistically significant difference (χ2=8.90,P=0.031). Spearman correlation analysis showed that BMI, 24 h SBP, daytime SBP, nighttime SBP, triglyceride, uric acid, and serum sodium level were positively correlated with LVMI (r=0.43, 0.20, 0.18, 0.18, 0.18, 0.16, and 0.12, all P<0.05). BMI, hyperinsulinemia, and cholesterol level were positively correlated with relative wall thickness (RWT) (r=0.22, 0.12, and 0.16, all P<0.05). The multivariate logistic regression analysis showed that BMI (OR=1.17, 95%CI 1.10-1.25) and 24 h SBP (OR=1.04, 95%CI 1.01-1.08) were the independent risk factors for LVH (both P<0.05). The area under the receiver operator characteristic curve, combined with BMI and 24 h SBP, was 0.72 (95%CI 0.67-0.77, P<0.05), with a sensitivity and specificity of 71.5% and 64.8%, respectively. Conclusions: BMI and 24 h SBP are the independent risk factors for LVH in children with primary hypertension, and the combination of BMI and 24 h SBP has an acceptable diagnostic value for LVH. Early monitoring of these indexes is necessary to predict preclinical cardiac damage.

Association of serum transforming growth factor β1 with left ventricular hypertrophy in children with primary hypertension

The current study was designed to assess the association of serum transforming growth factor β1 (TGF-β1) with left ventricular hypertrophy (LVH) in children with primary hypertension. The present single-center prospective trial examined 182 patients diagnosed with primary hypertension in Children’s Hospital, Capital Institute of Pediatrics, between January 2021 and September 2022. Clinical data were analyzed, and ambulatory blood pressure was assessed for 24 h. LVH, the commonest subclinical cardiac feature of hypertension, was assessed by echocardiography. According to left ventricular geometry, cases were assigned to the LVH (n = 44) and normal geometry (n = 138) groups. Serum TGF-β1 amounts were quantitated by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were established to analyze various variables for their predictive values in LVH. Among 182 children with primary hypertension, the concentrations of serum TGF-β1 were higher in stage 2 hypertension than in stage 1 (47.3 (38.8, 52.5) vs. 46.0 (38.6, 48.2) ng/L, Z = − 2.376; P = 0.018). Additionally, serum TGF-β1 content showed a positive correlation with BP levels (P < 0.05). TGF-β1 amounts were significantly elevated in the LVH group compared with the normal geometry group (51.7 (46.1, 54.9) vs. 46.1 (38.7, 48.1) ng/L, Z = − 4.324; P = 0.0000). Serum TGF-β1 content was positively associated with LVH (r = 0.321, P = 0.0000). Multivariable logistic regression analysis showed BMI (OR = 1.188, 95% CI 1.082–1.305; P = 0.0000) and elevated serum TGF-β1 content (OR = 1.063, 95% CI 1.016–1.113; P = 0.009) independently predicted LVH. A multivariable logistic regression model considering BMI and TGF-β1 content in LVH prediction was 0.771, with sensitivity and specificity of 72.7% and 70.3%, respectively.Conclusion: These data revealed an association of serum TGF-β1 with BP in children with primary hypertension. Serum TGF-β1 concentration was positively correlated with hypertensive cardiac damage. Serum TGF-β1 might constitute a valuable molecular marker for the prediction of LVH in children with primary hypertension. The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension, which may provide a new reference index for early clinical identification of hypertensive cardiac damage.What is Known:• Experimental and clinical data indicated TGF-β1 is involved in BP elevation.• TGF-β1 is positively correlated with LVMI and hypertrophy in adults.What is New:• Our current study reveals an association of serum TGF-β1 with BP in children with primary hypertension.• Elevated serum TGF-β1 level is positively associated with LVH in children with primary hypertension.• The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension.

Pathophysiology of primary hypertension in children and adolescents.

The progress in research on the physiology of the cardiovascular system made in the last 100years allowed for the development of the pathogenesis not only of secondary forms of hypertension but also of primary hypertension. The main determinants of blood pressure are described by the relationship between stroke volume, heart rate, peripheral resistance, and arterial stiffness. The theories developed by Guyton and Folkow describe the importance of the volume factor and total peripheral resistance. However, none of them fully presents the pathogenesis of essential hypertension. The multifactorial model of primary hypertension pathogenesis developed by Irving Page in the 1940s, called Page's mosaic, covers most of the pathophysiological phenomena observed in essential hypertension. The most important pathophysiological phenomena included in Page's mosaic form a network of interconnected "nodes". New discoveries both from experimental and clinical studies made in recent decades have allowed the original Page mosaic to be modified and the addition of new pathophysiological nodes. Most of the clinical studies confirming the validity of the multifactorial pathogenesis of primary hypertension concern adults. However, hypertension develops in childhood and is even perinatally programmed. Therefore, the next nodes in Page's mosaic should be age and perinatal factors. This article presents data from pediatric clinical trials describing the most important pathophysiological processes associated with the development of essential hypertension in children and adolescents.

Hipertenzija kod dece i adolescenata

Until recently, secondary hypertension used to be the most common form of hypertension in the paediatric population. Due to the increasing prevalence of obesity-related hypertension in children and adolescents, the share of secondary hypertension has decreased from 85% to 9%. Today, primary hypertension has become the dominant form of hypertension in the paediatric population. The purpose of this paper is to show the prevalence of various forms of hypertension and the prevalence of primary hypertension in children and adolescents relative to sex, age and body weight category in the General Hospital "Dr. Laza K. Lazarević" in Šabac. In children with secondary hypertension, the impact of body weight was not assessed since an organic cause of hypertension had been identified in these patients. All children from the age of a new-born to the age of 18 years with a diagnosis of hypertension (International Classification of Diseases, tenth revision (IDC-10), code I10-I15) in the period from 1 January 2013 to 31 December 2022 were selected from the medical digital database. This analysis included all children who showed blood pressure values above 95th percentile for age, sex and height in children under 13 and above 120/80 mmHg in children over 13, upon repeated measurements of blood pressure in the General Hospital, who were presumed to have hypertension. These children were referred to further evaluation at tertiary healthcare institutions, where a diagnosis of hypertension was made. Of the 134 children referred to the General Hospital due to elevated blood pressure levels measured in the primary care physician's office, hypertension was diagnosed in almost one in four subjects (24.6%). Primary hypertension was diagnosed in 18 (54.5%), secondary hypertension in 8 (24.2%) and white coat hypertension in 7 (21.2%) children. Primary hypertension was more common in boys (70.6%) than girls (37.5%). Among children with primary hypertension, overweight and obese children represented 66.7% of the group at the time of diagnosis. Statistical data analysis did not find a statistically significant difference in the prevalence of primary hypertension among the body weight or age categories. Since primary hypertension is the most significant and potentially reversible factor for the development of cardiovascular disease, early detection and treatment of primary hypertension in children is crucial in the prevention of cardiovascular disease in adults.

Serum free fatty acid level in children with primary hypertension

To examine the serum level of free fatty acid (FFA) in children with primary hypertension and its value in the pathogenesis, prevention, and treatment of primary hypertension in children. In this retrospective study, 34 children with primary hypertension who were treated for the first time in Children's Hospital Affiliated to Capital Institute of Pediatrics from January to June, 2021, were enrolled as the hypertension group, and 32 children with normal blood pressure who underwent physical examination during the same period were enrolled as the control group. The two groups were compared in terms of the levels of fasting serum FFA, fasting serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C). The multivariate logistic regression model was used to analyze the influence of FFA on the development of primary hypertension. Compared with the control group, the hypertension group had significantly higher body mass index (BMI), systolic blood pressure, and diastolic blood pressure (P<0.05), as well as significantly higher serum levels of FFA, TG, LDL-C, and non-HDL-C and a significantly lower serum level of HDL-C (P<0.05). Compared with the control group, the hypertension group had significantly higher rates of elevated serum FFA (>0.45 mmol/L for girls and >0.60 mmol/L for boys) (P<0.05) and abnormal blood lipid levels (abnormality in at least one index among serum TG, TC, LDL-C, HDL-C, and non-HDL-C) (P<0.05). A multivariate logistic regression equation was established based on age, sex, BMI, elevated serum FFA, and abnormal blood lipid levels, and the results showed that elevated serum FFA was an independent risk factor for primary hypertension in children (OR=17.560, 95%CI: 1.964-157.003, P<0.05). There is a significant increase in serum FFA level in children with primary hypertension, and the increase in serum FFA can increase the risk of primary hypertension in children.

The enigma of primary hypertension in childhood.

Beginning in the 1970s, hypertension in children and adolescents has been defined as systolic and/or diastolic blood pressure (BP) that is equal to or greater than the 95th percentile of the normal BP distribution in healthy children. The definition of hypertension in adults is based on longitudinal data that links a BP level with an increased risk for subsequent adverse outcomes related to hypertension including heart failure, kidney failure, stroke, or death. The statistical definition of hypertension continues to be used in childhood because there have been no data that link a BP level in childhood with a heightened risk for adverse outcomes in adulthood. Findings from clinical and epidemiologic research have advanced understanding of high BP in childhood. While hypertension in some children can be secondary to underlying kidney, cardiovascular, or endocrine disorder, it is now known that primary (essential) hypertension can be present in childhood. The prevalence of hypertension in childhood is approximately 2-5% and another 13-18% of children and adolescents have elevated BP and are at heightened risk for developing hypertension. The leading cause of childhood hypertension is primary hypertension, especially in adolescents. For children and adolescents with secondary hypertension, the treatment can focus on managing the underlying cause of hypertension. Less is known about managing primary hypertension in childhood, including diagnosis, evaluation, treatment, and possibilities for prevention. The phenotype of primary hypertension in childhood and recent findings will be discussed.

Evaluation of Renin, Aldosterone, Angiotensin, and Lipid Metabolism Genes and Genotype-Phenotype Relationship in Childhood Primary Hypertension Pathogenesis

Evaluation of Renin, Aldosterone, Angiotensin, and Lipid Metabolism Genes and Genotype-Phenotype Relationship in Childhood Primary Hypertension Pathogenesis

Association between MTHFR gene polymorphism and primary hypertension in children

To study the distribution characteristics of methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in children with primary hypertension, and to explore the association between MTHFR C677T gene polymorphism and H-type hypertension in children. A total of 121 children with primary hypertension who were hospitalized in the department of cardiovascular medicine from January to July 2021, newly diagnosed, and untreated were retrospectively selected as the subjects. The children were divided into three groups: CC genotype (19 children), CT genotype (51 children), and TT genotype (51 children). According to the serum homocysteine (Hcy) level, they were divided two groups: H-type hypertension (47 children) and simple hypertension (74 children). The medical data were compared between the groups. The association between MTHFR C677T gene polymorphism and H-type hypertension was evaluated. The mutation frequency of T allele in children with primary hypertension was significantly higher than that in healthy adults in Beijing and Chinese Han adults (P<0.001). The serum Hcy level in the TT genotype group was significantly higher than that in the CC and CT genotype groups (P<0.001). The serum Hcy level in the H-type hypertension group was significantly higher than that in the simple hypertension group (P<0.001), and MTHFR C677T was mostly TT genotype, which was associated with the risk of H-type hypertension (OR=12.71, P<0.001). There was no significant difference in the incidence rate of target organ damage between the H-type hypertension and simple hypertension groups (P>0.05). However, multiple organ involvement was observed in the H-type hypertension group at diagnosis, accounting for 11% (5/47). The mutation rate of MTHFR C677T T allele in children with primary hypertension is high and associated with the serum Hcy level. TT genotype is an independent risk factor for H-type hypertension in children, and it may be related to the severity of early target organ damage.

Plasma Fibroblast Growth Factor 23 as a Predictor for Fosinopril Therapeutic Efficacy in Pediatric Primary Hypertension.

BackgroundPlasma fibroblast growth factor 23 (FGF23) has been reported to be a predictive biomarker for therapeutic effectiveness of angiotensin‐converting enzyme inhibitors in heart failure. Higher plasma FGF23 levels have been shown in pediatric primary hypertension, but the predictive value of FGF23 for angiotensin‐converting enzyme inhibitors’ effectiveness in pediatric primary hypertension has not been documented.Methods and ResultsThis is a prospective study. An exploratory study with 139 patients was first conducted to determine the cutoff value of FGF23 for the prediction of treatment responsiveness. After receiving fosinopril for 4 weeks, of all 139 patients, 91 responded, while 48 did not respond to the treatment, and the responders had a significantly higher baseline plasma FGF23 level than nonresponders (P<0.01). Multiple regression analysis revealed a significant impact of baseline plasma FGF23 levels on fosinopril responsiveness (P<0.05). The receiver operating characteristic curve analysis showed that the plasma FGF23 predicted the effectiveness of fosinopril treatment with an area under the curve of 0.784 (95% CI, 0.704–0.863) for a sensitivity and a specificity of 67.0% and 89.6%, respectively, for a cutoff value of 62.08 RU/mL. Subsequently, another group of 40 patients were recruited for validation. The blood pressure control rate in those (n=22) with baseline plasma FGF23 >62.08 RU/mL was significantly higher than that in children (n=18) with FGF23 ≤62.08 RU/mL (P<0.05).ConclusionsPlasma FGF23 might be a valuable biomarker to guide fosinopril therapy for primary hypertension in children.

Magnetic Resonance Imaging in Childhood Primary Hypertension: Potential in the Study of Cognitive Outcomes.

Primary hypertension in youth and young adulthood is associated with decreased neurocognitive test performance both in midlife and during youth itself, leading to concern of subsequent cognitive decline and dementia in later life. The early vascular effects of hypertension in youth are likely involved in the pathogenesis of hypertensive target organ damage to the brain, but the potential impact of antihypertensive treatment from youth on subsequent cognitive health is not known. This review will highlight the need to answer the question of whether treatment of hypertension from early in life would slow cognitive decline in adulthood, and will then outline, for the nonneurologist, magnetic resonance imaging techniques potentially useful in the study of the pathogenesis of decreased cognition in hypertensive youth and for use as potential biomarkers for early antihypertensive treatment interventions.

Factors Associated with Primary Hypertension in Pediatric Patients: An Up-to-Date.

Arterial hypertension in children is considered a common alteration nowadays, mainly because obesity is a growing worldwide problem closely related to increased blood pressure. Childhood hypertension can be classified as primary or secondary, depending on the etiology. Primary or essential hypertension still has its pathophysiology not fully elucidated, and there is no consensus in the literature on most underlying mechanisms. In this review, genetic and environmental factors, including sodium and potassium intake, socioeconomic status, ethnicity, family structure, obesity, sedentary lifestyle, prematurity and low birth weight, prenatal and postnatal exposures are highlighted. The present study aimed to perform an update on primary hypertension in childhood, providing clinicians and researchers an overview of the current state of the literature regarding the influence of genetic and environmental factors. This integrative review searched for articles on genetic and environmental factors related to primary hypertension in pediatric patients. The databases evaluated were PubMed and Scopus. The studies have provided insights regarding many genetic and environmental factors, in addition to their association with the pathophysiology of primary hypertension in childhood. Findings corroborated the idea that primary hypertension is a multifactorial disease. Further studies in the pediatric population are needed to elucidate the underlying mechanisms. The study of primary hypertension in pediatrics has utmost importance for the adoption of preventive measures and the development of more efficient treatments, therefore reducing childhood morbidity and the incidence of cardiovascular diseases and other health consequences later in life.

Dental caries-related primary hypertension in children and adolescents: Cross-sectional study.

Hypertension is a growing clinical problem in pediatric population. Also, the cause of hypertension is usually unknown and it may result from systemic inflammation related to tooth decay. To estimate the potential association in cross-sectional study between tooth decay and hypertension in children and adolescents. Study group-65 children diagnosed with primary arterial hypertension; control subjects-44 normotensive children. Blood pressure, dental examination, measurement of salivary cortisol, alpha-amylase, secretory IgA, and lysozyme concentrations were performed in all of the children. Hyper- and normotensive children had similar peripheral blood morphology and serum biochemical parameters, except of uric acid concentration, which was significantly higher in the study group (p=.047). Salivary evening concentrations of cortisol and alpha-amylase were significantly higher in hypertensive children (p=.002 and p=.004, respectively). Although 24-hr systolic blood pressure (SBP), including daytime and nighttime SBP, correlated with "decay," "microalbuminuria," "BMI," and "glomerular filtration rate" (r>.75, r>.7, r<.68, and r<.43, respectively), in multivariate analysis only "decay" was associated with hypertension both in children and in adolescents (p<.0001). Tooth decay in children/adolescents might be regarded as a potent trigger factor of hypertension in individuals in whom all other causes of secondary arterial hypertension have been excluded.

Origins of Primary Hypertension in Children: Early Vascular or Biological Aging?

Although relatively rare in childhood, primary hypertension (PH) is thought to have originated in childhood and may be even determined perinatally. PH prevalence increases in school-age children and affects 11% of 18-year-old adolescents. Associated with metabolic risk factors, elevated blood pressure in childhood is carried into adulthood. Analysis of the phenotype of hypertensive children has revealed that PH is a complex of anthropometric and neuro-immuno-metabolic abnormalities, typically found in hypertensive adults. Children with elevated blood pressure have shown signs of accelerated biological development, which are closely associated with further development of PH, metabolic syndrome, and cardiovascular disease in adulthood. At the time of diagnosis, hypertensive children were reported to have significant arterial remodelling expressed as significantly increased carotid intima-media thickness, increased stiffness of large arteries, lower area of microcirculation, and decreased endothelial function. These changes indicate that their biological age is 4 to 5 years older than their normotensive peers. All these abnormalities are typical features of early vascular aging described in adults with PH. However, as these early vascular changes in hypertensive children are closely associated with features of accelerated biological development and neuro-immuno-metabolic abnormalities observed in older subjects, it seems that PH in childhood is not only an early vascular aging event, but also an early biological maturation phenomenon.

Clinical, instrumental and morphological parallels in combination of chronic gastroduodenitis and primary hypertension in children

The aim: to provide clinical and instrumental characteristics and to evaluate the morphological changes of the stomach and duodenum mucous membrane in children with comorbidity of chronic gastroduodenitis (HGD) and primary hypertension (PH).Materials and methods. 102 children aged 9–17 years with HGD and PH were examined. The first group consisted of 47 children with a combination of HGD and PН, the second group – 55 children with HGD and normal arterial pressure. Morphological study of biopsy specimens of the stomach and duodenum mucous membrane (MM) was performed in 33 children.Results. Gastroduodenoscopy showed an erythematous gastroduodenopathy in 57.4 % of children in group І and 60.0 % of children in group ІІ (P = 0.79), hypertrophic changes in the stomach and duodenal ММ – in 6.4 % of children in group І and 12.7 % of children in group II (P = 0.28), subatrophy – in 10.6 % of children in group І and 14.5 % of children in group II (P = 0.56), erosion – in 25.5 % of children in group І and 12.7 % of children in group ІІ (P = 0.1), motor-evacuation disorders – in 63.8 % of children in group І and 41.8 % of children in group ІІ (Р = 0.03). Unlike this data, the morphological study of the MM biopsy revealed a statistically significant difference in microcirculatory disturbances in the MM, namely plethora was detected in 81.3 % of children in group I and 52.9 % of children in group II (P = 0.02), severe edema was observed in 75.0 % of children in group I and 41.2 % of children in group II (P = 0.049), hemorrhages in the lamina propria – in 62.5 % of children in group I and 23.5 % of children in group II (P = 0.02), microtrombosis – in 37.5 % of children in group I and 5.9 % of children in group II (P = 0.03), as well as concerning destructive changes in the MM: micro-erosion were found in 56.3 % of children in group I and 17.6 % of children in group II (Р = 0.02), erosion – in 43.8 % of children in group І and 11.8 % of children in group II (P = 0.04).Conclusions. The combined course of HGD and PH in children is characterized by more frequent motor-evacuation and microcirculatory disorders (plethora, severe edema, hemorrhages in the lamina propria, microtrombosis), as well as more pronounced erosive changes in the MM as compared to an isolated course of HGD.

Hemodynamic Characterization of Primary Hypertension in Children and Adolescents.

BackgroundPrimary hypertension in children is often characterized by high pulse pressure that could be attributable to increased ventricular ejection velocities and volumes and/or increased arterial stiffness. The objective of this study was to examine the contributions of cardiac (ventricular ejection) and vascular (systemic vascular resistance, arterial stiffness, and pressure wave reflection) properties to primary hypertension in children and adolescents.Methods and ResultsChildren aged 8 to 18 years referred to a tertiary center for evaluation of hypertension and found to have primary hypertension (n=31) were compared with normotensive controls of similar age (n=50). Peripheral (brachial) and central (carotid) blood pressure waveforms and carotid‐femoral pulse wave velocity were measured by tonometry. Left ventricular outflow tract velocities and ejection volumes were measured by echocardiography. Wave separation and wave intensity analysis were used to assess pressure wave propagation. Increased mean arterial pressure in hypertensive children (90±15 versus 76±10 mmHg in hypertensive versus normotensive children; means±SD; P<0.001) was explained by increased heart rate and cardiac output (5.3±2.0 versus 4.5±1.2 L/min adjusted for age and sex; P<0.05) rather than increased systemic vascular resistance (18.0±4.6 versus 19.3±7.3 mmHg/min/mL; P=0.374). A more‐marked increase in pulsatility (peripheral pulse pressure 66±21 versus 46±12 mmHg; P<0.001) was explained by increased proximal aortic stiffness (pulse wave velocity, 3.3±1.4 versus 2.5±0.8 m/s; P<0.005) and increased left ventricular ejection velocity (1.33±0.24 versus 1.21±0.18 m/s; P<0.05).ConclusionsCardiac overactivity characterized by increased heart rate and left ventricular ejection velocities and increased proximal pulse wave velocity may be the main cause of primary hypertension in children.

Impact of Birth Weight and Length on Primary Hypertension in Children.

Background: A child’s birth parameters not only enable assessment of intrauterine growth but are also helpful in identifying children at risk of developmental defects or diseases occurring in adulthood. Studies show that children born with a body weight that is small for their gestational age (SGA) are at a greater risk of hypertension though the inverse relation between excessive birth weight and the risk of primary hypertension in children is discussed less frequently. Purpose: To assess the impact of both birth weight and length on hypertension occurring in children aged 3–15 years. Methods: A total of 1000 children attending randomly selected primary schools and kindergartens were examined. Ultimately, the analyses took into account n = 747 children aged 4–15; 52.6% boys and 47.4% girls. The children’s body height and weight were measured; their blood pressure was examined using the oscillometric method. Information on perinatal measurements was retrieved from the children’s personal health records. Results: Compared to the children with small for gestational age (SGA) birth weight, the children with appropriate for gestational age birth weight (AGA) (odds ratio (OR) 1.31; 95% confidence interval (CI) 0.64–2.65) present greater risk for primary hypertension. Infants born with excessive body weight >4000 g irrespective of gestational age, compared to infants born with normal body weight, show increased risk of primary hypertension (OR 1.19; 95% CI 0.68–2.06). Higher risk of hypertension is observed in infants born with greater body length (OR 1.03; 95% CI 0.97–1.08). Conclusions: The problem of hypertension may also affect children with birth weight appropriate for gestational age. The prevalence of hypertension in children with AGA birth weight decreases with age. Birth length can be a potential risk factor for hypertension in children and adolescents.