Body Mass Index (BMI) Is the Strongest Predictor of Systemic Hypertension and Cardiac Mass in a Cohort of Children

Abstract

Background: Hypertension (HTN) is a well-established cardiovascular (CV) risk factor in adults. The presence of HTN in children appears to predict its persistence into adulthood. Early diagnosis of HTN is crucial to reduce CV morbidity before the onset of organ damage. Aim: The aim of this study is to investigate cardiac damage in HTN, its risk factors (RFs), and evolution. Methods: We conducted a prospective/retrospective study involving children referred to the Childhood Hypertension Outpatient Clinic. This study included clinical and echocardiographic assessments of cardiac morphology and function at three time points: enrollment (T0) and follow-up (T1 and T2). Results: Ninety-two patients (mean age 11.4 ± 3 years) were enrolled. Cardiac eccentric and concentric hypertrophy were present in 17.9% and 9%, respectively, with remodeling in 10.5%. Overweight/obese subjects exhibited significantly higher systolic blood pressure (SBP), frequency of HTN, and body mass index (BMI) at T0 compared with patients with chronic kidney disease (CKD). SBP and BMI persisted more during follow-up. Normal-weight vs. overweight/obese patients were significantly more likely to have normal geometry. Positive correlations were found between BMI and left ventricular (LV) mass at T0, BMI and SBP at T0 and T1. Gender, BMI, SBP, and diastolic blood pressure (DBP) significantly predicted LV mass index (LVMI), but only BMI added significance to the prediction. During follow-up, the variation of BMI positively correlated with the variation of SBP, but not with LVMI. Conclusions: In our cohort, body weight is strongly associated with HTN and cardiac mass. Importantly, the variation in body weight has a more significant impact on the consensual variation of cardiac mass than blood pressure (BP) values. A strict intervention on weight control through diet and a healthy lifestyle from early ages might reduce the burden of CV morbidity in later years.

Association Between Elevated Body Mass Index and Cardiac Organ Damage in Children and Adolescents: Evidence and Mechanisms

“…The main study findings can be summarized as follows. First, confirming recent findings [ 8 , 9 , 11 , 22 ] markers of obesity such as body weight, BMI and waist circumference are strongly correlated LVMI in a pediatric population homogeneous in terms of biochemical profile and BP parameters. Second, the correlation was detected not only with left ventricular mass, but also with left atrial dimensions and RWT, i.e.…”

“…However, the relative contribution of hemodynamic vs non-hemodynamic factors at the development of the above mentioned association remains at present unsettled, due to heterogeneity of the populations examined as well as to the presence of confounding factors [ 10 ]. A prospective/retrospective study very recently suggested the importance of body weight as determinant of left ventricular mass in a cohort of children [ 11 ].…”