Left Ventricular Geometry and Severe Left Ventricular Hypertrophy in Children and Adolescents With Essential Hypertension

Abstract

Background-Left ventricular (LV) hypertrophy has been established as an independent risk factor for cardiovascular disease in adults. Recent research has refined this relationship by determining a cutpoint of 51 g/m 2.7 for LV mass index indicative of increased risk and defining LV geometric patterns that are associated with increased risk. The purpose of this study was to evaluate severe LV hypertrophy and LV geometry in children and adolescents with essential hypertension. Methods and Results-A cross-sectional study of young patients (nϭ130) with persistent blood pressure elevation above the 90th percentile was conducted. Nineteen patients (14%) had LV mass greater than the 99th percentile; 11 of these were also above the adult cutpoint of 51 g/m 2.7 . Males, subjects with greater body mass index, and those who had lower heart rate at maximum exercise were at significantly (PϽ.05) higher risk of severe LV hypertrophy. In addition, 22 patients (17%) had concentric LV hypertrophy, a geometric pattern that is associated with increased risk of cardiovascular disease in adults. Seven patients had LV mass index above the cutpoint and concentric hypertrophy. No consistent significant determinants of LV geometry were identified in these children and adolescents with hypertension. Conclusions-Severe LV hypertrophy and abnormal LV geometry are relatively prevalent in young patients with essential hypertension. These findings suggest that these patients may be at risk for future cardiovascular disease and underscore the importance of recognition and treatment of blood pressure elevation in children and adolescents. Weight loss is an important component of therapy in young patients with essential hypertension who are overweight. (Circulation. 1998;97:1907-1911.)

Relationship of home blood pressure with target-organ damage in children and adolescents

“…18 However, some studies failed to reveal an independent association of casual and/or ambulatory systolic/diastolic BP with LVMI or the presence of left ventricular hypertrophy, implying that factors such as the duration of hypertension or the characteristics of the study population (age, gender, presence of obesity or other comorbidities) may have an important role. [31][32][33] In the present study, LVM was significantly associated with systolic BP (mainly HBP and ABP and less so for CBP), nevertheless, LVMI was not significantly associated with systolic BP irrespective of the method used. This might be attributed, at least in part, to the fact that LVMI is an index corrected for body size, whereas BP (which in the pediatric population greatly varies according to age and body size) was used in the analyses unadjusted.…”

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…Among children and adolescents with primary HTN, 30-40% had a left ventricular mass index (LVMi) above the 95th percentile and 10-15% of them had severe left ventricular hypertrophy (LVH) defined as LVMi above 51g/height 2.7 (17)(18)(19). Renal damage is rarely observed in essential hypertensive children, but these subjects have greater albuminuria and excrete more N-acetyl glicosamine than their normotensive counterparts.…”

“…Assessment of LVM and geometry remain a cornerstone when looking for end-organ damage in sustained pediatric HTN (17,103). The ratio of Doppler transmitral flow (E) and tissue Doppler derived early diastolic velocity (E´), reflecting diastolic function, independently predicts primary cardiac events in hypertensive adults (110).…”

Management of childhood obesity: a challenging but also a fascinating issue

“…The arguments presented by Dr Daniels included an emphasis on the fact that obesity can amplify the severity of a pathological condition. 1 Indeed, by referring to his own clinical experience, 2 he showed that 'among children and adolescents with hypertension, increased BMI is associated with more severe increase in left ventricular mass index,' which may ultimately predict a large increase in the risk of cardiovascular end points in adulthood.…”