Improvement of left ventricular mass with antihypertensive therapy in children with hypertension

Abstract

There is paucity of data on the regression of left ventricular hypertrophy (LVH) in hypertensive children. This study assessed the effects of antihypertensive therapy on left ventricular mass in children with and without LVH. Medical records of hypertensive patients who had a baseline and follow-up echocardiogram (echo 1, echo 2) were reviewed. Fifteen of 22 treated patients had LVH at echo 1. Enalapril alone or combined was used in 21/22 cases. Echo 2 was performed at a mean interval of 15 +/- 7 months. The LVH group showed significant decrease in systolic blood pressure z-score (SBPZ) (2.89 +/-1.61 to 1.40 +/- 1.19; p=0.01), diastolic blood pressure z-score (DBPZ) (1.44 +/- 0.90 to 0.26 +/- 0.82; p<0.001), and LV mass index (LVMI) (56.2 +/- 12.50 to 43.7 +/- 8.30; p=0.001), but no significant change in body mass index z-score (BMIZ) (1.79 +/- 0.75 to 1.69 +/- 0.69; p=0.74). In the no-LVH group, SBPZ (3.03 +/- 1.68 to 2.27 +/- 1.81; p=0.356), DBPZ (1.00 +/- 0.87 to 0.63 +/- 0.68; p=0.409), BMIZ (1.08 +/- 0.98 to 1.27 +/- 0.89; p=0.672), and LVMI (29.47 +/- 5.51 to 33.89 +/ -3.06;p=0.374) did not change significantly. Simple linear regression demonstrated that the change in LVMI in the combined group had a significant correlation (r=0.477; p=0.025) with the percentage change in SBPZ. This study demonstrates that LVH in hypertensive children improves with effective blood pressure control.

The Reproducibility and Absolute Values of Echocardiographic Measurements of Left Ventricular Size and Function in Children Are Algorithm Dependent

“…The short axis view may be especially advantageous in this setting, because of the systolic lateral motion of the LV that can occur in children. In fact, the short axis is preferred in many studies involving children, which utilize linear dimension assessment of the LV (7, 8). Additionally, the apical 2-chamber view is less frequently utilized in pediatric laboratories, in part because the small rib spaces in children makes the view more technically challenging.…”

Control of Hypertension in Treated Children and Its Association With Target Organ Damage

“…In these rare studies, it could be demonstrated that antihypertensive therapy could induce regression of LVH. [24][25][26] However, no study focused on the association of achieved control of HT with the prevalence of LVH. In our study, children with treated but uncontrolled HT had three times higher prevalence of LVH than children with controlled HT (Figure 2).…”

Reduction of Risk for Cardiovascular Disease in Children and Adolescents

“…This means that several classes including diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers and beta adrenergic blockers could be chosen as first-line agents. There are preliminary data demonstrating that pharmacologic treatment can be effective in lowering left ventricular mass as well as blood pressure in children (68). …”