Regression of Left-Ventricular Hypertrophy in Children and Adolescents With Hypertension During Ramipril Monotherapy

Seeman, Tomáš; Gilík, Jiří; Vondrák, Karel; Šimková, Eva; Flögelová, Hana; Hladíková, Marie; Janda, Jan

doi:10.1016/j.amjhyper.2007.03.009

Cited by 69 publications

(47 citation statements)

References 31 publications

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“…The relationship of LV concentricity with BP may have been partially concealed by the common use of RAS antagonists, the use of which was associated with a reduced rate of concentric LVH. RAS antagonists may attenuate myocardial remodeling in a partially BP-independent manner by antagonizing the effects of locally formed angiotensin II, resulting in reduced myocyte hypertrophy, fibroblast proliferation, matrix formation, and myocardial fibrosis (23)(24)(25). Volume status was the second most important parameter affecting the risk of LVH in dialyzed children.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis

Bakkaloğlu

Borzych

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow-up in dialyzed children.Design, setting, participants, & measurements Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95 th percentile of LV mass index relative to height age was used to define LVH. ResultsThe overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia.Conclusions Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH.

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Section: Discussionmentioning

confidence: 99%

Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis

Bakkaloğlu

Borzych

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…The severity of albuminuria correlates with LVH (20,21). On the other hand antihypertensive treatment when successful in reducing BP, also leads to regression of LVH, decrease in carotid intima-media thickness (cIMT) and normalization of microalbuminuria (22)(23)(24). Likewise, in children with chronic kidney disease (CKD) proteinuria correlates with BP, and strict BP control leads to a decrease in proteinuria and a slowing of the progression of CKD (25).…”

Section: Relative Cardiovascular and Renal Riskmentioning

confidence: 99%

“…Nonetheless, there is pediatric evidence that effective antihypertensive treatment induces regression of LVH, ameliorates cardiac geometry and function (22,23,(174)(175)(176). In children with CKD receiving angiotensin converting enzyme inhibitors (ACEi), improved BP control resulted in LVH regression and improved systolic function within 12 months of treatment.…”

Section: Heartmentioning

confidence: 99%

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

Lurbe

Agabiti‐Rosei

Cruickshank

et al. 2016

Journal of Hypertension

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“…Hermida et al 51,52 provided the proof of concept. The classification of patients according to the night-to-day blood pressure ratio heavily depends on arbitrary criteria, is poorly reproducible, 48,[53][54][55] and has a different prognostic meaning according to the outcome under study, 29 the prevailing 24-hour blood pressure level, 29 and treatment status. 29 Reverse dippers have the highest cardiovascular risk but die at an older age than do subjects with a normal dipping pattern, which raises the issue of reverse causality.…”

Section: Hansen Et Al Risk Prediction From Nighttime Blood Pressurementioning

confidence: 99%

Predictive Role of the Nighttime Blood Pressure

et al. 2011

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Abstract-Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies to prospective outcomes, and lack of comprehensive adjustments for confounders make interpretation of the literature difficult. We reviewed prospective studies with total mortality or a composite cardiovascular end point as an outcome in relation to the level and the circadian profile of systolic BP. We analyzed studies in hypertensive patients (nϭ23 856) separately from those in individuals randomly recruited from populations (nϭ9641). We pooled summary statistics and individual subject data, respectively. In both patients and populations, in analyses in which nighttime BP was additionally adjusted for daytime BP and vice versa, nighttime BP was a stronger predictor than daytime BP. With adjustment for the 24-hour BP, both the night-to-day BP ratio and dipping status remained significant predictors of outcome but added little prognostic value over and beyond the 24-hour BP level. In the absence of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation of ambulatory BP recording need to be updated. (Hypertension. 2011;57:3-10.) • Online Data Supplement Key Words: ambulatory blood pressure monitoring Ⅲ dipping status Ⅲ nighttime blood pressure Ⅲ night-to-day blood pressure ratio Ⅲ population science Ⅲ risk factors A mbulatory monitoring enables recording the blood pressure throughout the entire day, while subjects engage in their usual day-to-day activities. 1,2 The diurnal blood pressure profile normally includes a 10% to 20% fall in blood pressure during sleep, which is driven by physical inactivity and which is largely independent of an endogenous rhythm. 3 Indeed, in shift workers, the 24-hour blood pressure level and the fall in blood pressure during sleep were similar on days with daytime and nighttime work. 3 In 1988, O'Brien et al 4 reported for the first time that patients with an abnormal circadian blood pressure profile with a less marked decrease in the nighttime blood pressure had a more frequent history of stroke. O'Brien and colleagues thereby coined the terms dipping versus nondipping. Subsequent studies of hypertensive cohorts 5-24 and populations [25][26][27][28][29][30] did not all 8,15,18,26,30 corroborate the worse prognosis associated with a high nighttime blood pressure. Moreover, interpretation of these studies is not always easy. First, positive results based on arbitrary and varying definitions of nondipping were sometimes not supported by analysis of the nocturnal blood pressure fall as a continuous variable. 7,15 Second, in some reports signific...

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Regression of Left-Ventricular Hypertrophy in Children and Adolescents With Hypertension During Ramipril Monotherapy

Abstract: Ramipril is an effective drug in children with hypertension, for its ability to reduce not only BP but also left-ventricular mass and induce regression of LVH.

Cited by 69 publications

References 31 publications

Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis

Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis

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

Predictive Role of the Nighttime Blood Pressure

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