Change in left ventricular geometry during antihypertensive treatment in children with primary hypertension

Abstract

The pattern of the left ventricle (LV) has important significance in adults with hypertension. The aim of the present study was to analyze changes and determinants of LV geometry after 1 year of antihypertensive treatment in children with primary hypertension (PH) in relation to metabolic abnormalities and anthropometrical parameters. In 86 children (14.1 ± 2.4 years) with newly diagnosed PH, LV geometry and biochemical parameters before and after 12 months of standard antihypertensive therapy were assessed. At baseline, normal LV geometry (NG) was found in 42 (48.9%), concentric remodeling (CR) in 4 (4.6%), concentric hypertrophy (CH) in 8 (9.3%), and eccentric hypertrophy (EH) in 32 (37.2%) patients. The prevalence of NG in patients with severe hypertension was significantly lower than in patients with ambulatory hypertension. There were no differences in dipping status in relation to LV geometry. Patients with CH and EH were more viscerally obese than patients with NG. Patients with CH had higher diastolic blood pressure in comparison with EH patients (p < 0.05). The main predictor of relative wall thickness (RWT) was the triglycerides to high density lipoprotein cholesterol (TG/HDL) ratio (R2 = 0.319, β = 0.246, p = 0.004). Patients received 12 months of antihypertensive treatment, either lifestyle modification only (n = 37) or lifestyle modification plus antihypertensive medications (n = 49) if severe ambulatory hypertension or target organ damage were present. After 12 months of treatment the prevalence of EH (37.2% vs 18.6%, p = 0.003) decreased but prevalence of CH did not change. Patients in whom RWT decreased also decreased waist circumference and TG/HDL; the main predictor of RWT decrease was a decrease of the TG/HDL ratio (β = 0.496, R2 = 0.329, p = 0.002). In adolescents with PH, LV geometry is related to central obesity and insulin resistance. Decrease of abdominal obesity and insulin resistance are the most important predictors of normalization of LV geometry, however CH has lower potential to normalize LV geometry.Electronic supplementary materialThe online version of this article (doi:10.1007/s00467-011-1916-8) contains supplementary material that is available to authorized users

Detection of early diastolic alterations by Tissue Doppler Imaging in untreated childhood-onset essential hypertension

“…Our study also demonstrated an increase in left ventricular mass and a higher likelihood of development of abnormal left ventricular geometry in children who had essential hypertension; eccentric hypertrophy being the most prevalent type of abnormal geometry (35). According to the literature in children, a high incidence of concentric hypertrophy is seen in the obese and hypertensive children (12, 36) and it is also the type that is less likely to regress (35).…”

“…According to the literature in children, a high incidence of concentric hypertrophy is seen in the obese and hypertensive children (12, 36) and it is also the type that is less likely to regress (35). Left ventricular hypertrophy is the most commonly assessed marker of target organ damage in hypertensive children with a prevalence of 10% to 38% (6, 7, 11, 36-41) and is a significant independent predictor of diastolic dysfunction in children with essential hypertension (14).…”

The role of blood pressure, body weight and fat distribution on left ventricular mass, diastolic function and cardiac geometry in children

“…Children with hypertension associated with obesity have the highest prevalence of cardiac geometry alterations, in particular, a great prevalence of both concentric and eccentric hypertrophy has been observed [20,52,57]. Moreover, Śladowska-Kozłowska et al [58] observed that eccentric hypertrophy was the most frequent pattern of left ventricular remodeling in adolescents with essential hypertension and central obesity. A greater prevalence of abnormal cardiac geometry was observed in prehypertensive and hypertensive adolescents, as compared to the normotensive ones, without an effect of weight [10,43].…”

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

“…Increased LVMI is defined as an increase in the mass of the left ventricle, which can be secondary to an increase in wall thickness, an increase in cavity size, or both. This increase in mass predominantly results from a chronic increase in the afterload of the left ventricle caused by hypertension and/or by chronic volume load (23)(24)(25). Aortic annulus diameter enlargement has been reported in children with hypertension other than Turner and Marfan syndromes (26,27).…”