Regression of target organ damage in children and adolescents with primary hypertension

Abstract

We assessed the effects of 12 months of non-pharmacological and pharmacological therapy on 24-h ambulatory blood pressure, regression of target organ damage (TOD) and metabolic abnormalities in 86 children (14.1 ± 2.4 years) with primary hypertension. Twenty-four hour systolic and diastolic blood pressure (BP) decreased (130 ± 8 vs 126 ± 8, 73 ± 7 vs 70 ± 7, p = 0.0001 and 0.004 respectively). Body mass index (BMI) did not change, but waist-to-hip (0.85 ± 0.07 vs 0.83 ± 0.05, p = 0.01) and waist-to-height ratio (WHtR; 0.49 ± 0.07 vs 0.48 ± 0.05, p = 0.008) decreased. Left ventricular mass index (LVMi; 38.5 ± 10.7 vs 35.2 ± 7.5 g/m2.7, p = 0.0001), prevalence of left ventricular hypertrophy (46.5% vs 31.4%; p = 0.0001), carotid intima-media thickness (cIMT; 0.44 ± 0.05 vs 0.42 ± 0.04 mm, p = 0.0001), wall cross sectional area (WCSA; 7.5 ± 1.3 vs 6.9 ± 1.2 mm2, p = 0.002), hsCRP (1.1 ± 1.0 vs 0.7 ± 0.7 mg/l, p = 0.002), and LDL-cholesterol (115 ± 33 vs 107 ± 26 mg/dl, p = 0.001) decreased. Patients who had lowered BP had a lower cIMT at the second examination (0.41 ± 0.04 vs 0.43 ± 0.04 mm, p = 0.04) and lower initial hsCRP values (0.9 ± 0.7 vs 1.5 ± 1.3 mg/l, p = 0.04) in comparison to non-responders. Regression analysis revealed that the main predictor of LVMi decrease was a decrease in abdominal fat expressed as a decrease in waist circumference (WC) (R2 = 0.280, β = 0.558, p = 0.005), for WCSA-SDS a decrease in WC (R2 = 0.332, β = 0.611, p = 0.009) and for a cIMT-SDS decrease the main predictor was a decrease in hsCRP concentrations (R2 = 0.137, β = 0.412, p = 0.03). Standard antihypertensive treatment lowered BP and led to regression of TOD in hypertensive children. Lean body mass increase and decrease in abdominal obesity correlated with TOD regression.

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

“…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).…”

“…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.…”

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

“…Also, the papers cited in the AAP guidelines do not report further reduction of left ventricular mass in children whose blood pressure was lowered below 90 th percentile [25]. It should also be noted that in children and adolescents with primary AH the strongest predictor of the reduction of left ventricular mass and the incidence of left ventricular hypertrophy is not a decrease in blood pressure values, but visceral fat reduction, expressed as waist circumference reduction, and normalization of metabolic disorders [26]. Taking the above into consideration, in the presented guidelines for children and adolescents with primary AH and without additional diseases, we recommend blood pressure levels lower than 95 percentile (or below 140/90 mmHg).…”

Cardiovascular Changes during Chronic Hypertensive States

“…In the patient cohort studied by Litwin et al, LVH was already present in 46 % of patients with newly diagnosed primary HTN. A standard antihypertensive treatment lowered the BP and led to the regression of target organ damage as evidenced by decreased LVMI and decreased cIMT [68]. The association between cIMT and MAP, as well as highsensitivity C-reactive protein in peritoneal dialyzed children has been reported.…”