Blood Pressure Variability and Left Ventricular Mass Index in Children

Abstract

Clinical implications of blood pressure variability (BPV) on subclinical organ damage in children are unknown. The authors sought to explore the potential utility of two newly derived BPV indices: weighted standard deviation (wBPSD) and real average variability (ARV), as well as two standard ambulatory blood pressure indices: average 24-hour systolic blood pressure (SBP) and 24-hour SBP load, to identify children at high risk for left ventricular (LV) hypertrophy (LVH). The study group consisted of 67 consecutive children who were referred to our institution for evaluation of suspected hypertension. LV mass was estimated by M-mode echocardiography using Devereux's formula according to the Penn convention and indexed for height 2.7 . We found a statistically significant, positive correlation between 24-hour wBPSD and LV mass index (LVMI) (q=0.389; P=.002) and no correlation between 24-hour ARV and LVMI (P>.05). However, partial correlation analysis of 24-hour wBPSD adjusted for body mass index (BMI) and LVMI showed only a weak correlation (q=0.3; P=.022). By using multiple linear regression analysis in a model with LVMI as a dependent variable and 24-hour wBPSD, 24-hour ARV, and BMI as independent variables, only BMI showed statistically significant independent positive associations with LVMI (P=.028). Results of our study showed that currently used BPV indices (24-hour wBPSD and 24-hour ARV) are not clinically reliable parameters to identify children at risk for LVH. Apparent contribution of the 24-hour wBPSD parameter to LVMI is negligible and is secondary to its close correlation with BMI (q=0.335 P=.009). J Clin Hypertens (Greenwich). 2013;15:905-909. ª2013 Wiley Periodicals, Inc.During the past decade, clinical and animal studies have examined an association between high blood pressure (BP) variability (BPV) and cardiovascular morbidity and mortality.

Blood Pressure Variability in Children With Primary vs Secondary Hypertension

“…While most research has suggested that BPV has prognostic value for many stages of CV disease, it is worth noting that a recent Russian study in adults found that 24‐hour BPV did not independently predict LVH . Also in agreement with our findings, a recent pediatric study found only a weak association between 24‐hour BPV and LVMI, and found no relationship between 24‐hour BPV and LVH in children evaluated for hypertension . Another pediatric study examined the relationship of 24‐hour BPV and LVH in pediatric patients with HTN .…”

“…36 Also in agreement with our findings, a recent pediatric study found only a weak association between 24-hour BPV and LVMI, and found no relationship between 24-hour BPV and LVH in children evaluated for hypertension. 37 Another pediatric study examined the relationship of 24-hour BPV and LVH in pediatric patients with HTN. 38 Investigators determined that daytime systolic SD had significant associations with LVMI after adjustment for age, sex, and BMI z score.…”

Blood pressure (BP) assessment—from BP level to BP variability

“…Sharma et al analyzed BP SD from ABPM recordings as a measure of BP variability and showed that in children with [3]. In contrast, more sophisticated indices of BP variability, such as the weighted standard deviation and ARV, showed only a weak correlation with the LVMI and were not considered as reliable parameters to identify children at risk for left ventricular hypertrophy [33]. It would appear however that increased BP variability may be associated with the progression of chronic kidney disease (CKD), as children with CKD and uncontrolled HTN have higher systolic and diastolic BP variability and lower HR variability; these can be classified as markers of sympathetic nervous system (SNS) overactivity and autonomic nervous system dysfunction [5].…”

Lipid profile and left ventricular geometry pattern in obese children

“…It is well established that the left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular and all-cause mortality and morbidity [1][2][3]. A few crosssectional studies have shown that male sex, age, genetics, hemodynamic overload, obesity, hormonal and metabolic factors correlate with LVH [4,5]. Previous studies have reported conflicting results concerning the relationship between serum lipid levels and left ventricular geometry pattern, both in general population and patients with cardiovascular risk [6][7][8][9].…”