Assessment of Early Cardiovascular Risk in Children and Adolescents with Essential Hypertension

Abstract

Objectives

The aim of our study was to investigate some early markers of hypertensive target organ damage in hypertensive children and adolescents, and to detect those showing most prominent clinical significance.

Methods

We included 100 children with essential hypertension (EH) and 50 age-matched healthy control children, and evaluated left ventricular mass (LVM), intima-media thickness in the carotid arteries (IMT), pulse wave velocity (PWV), microalbuminuria, biochemical parameters and some adipokines.

Results

Statistically significant differences between the 2 groups were observed for HDL-cholesterol, LDL-cholesterol, triglycerides, insulin, uric acid, glucose, apolipoprotein A1, and total adiponectin. The mean values of IMT, PWV and LVM were greater in hypertensive children, but only the differences in IMT and LVM were statistically significant. In addition, hypertensive children showed significantly higher values of AoSP (aortic systolic pressure), AoPP (aortic pulse pressure) and AIx@75 (augmentation index corrected for heart rate of 75 b.p.m.). Metabolic syndrome was diagnosed in 31% of hypertensive children.

Conclusions

A significant number of children with EH have early target organ changes as well as other risk factors, including metabolic syndrome, especially obese ones. However, IMT, LVM and some parameters of arterial stiffness have been found to be early markers in both obese and non-obese hypertensives. In addition, adipokines and coagulation factors seem to be important in obese hypertensives.

Zusammenfassung

Hintergrund

Das Ziel unserer Studie war es, einige frühe Zeichen hypertensiver Endorganschäden bei Kindern und Jugendlichen mit arterieller Hypertonie zu ermitteln um diejenigen zu finden, die klinisch am bedeutsamsten sind.

Patienten

Wir haben 100 Kinder und Jugendliche mit essentieller Hypertonie (EH) und 50 gleichaltrige gesunde Kinder und Jugendliche als Kontrollen in die Studie einbezogen.

Methoden

Die Studie beurteilte die linksventrikuläre Hypertrophie (LVM), die Intima Media Dicke der inneren Halsschlagader (IMT), die Pulswellengeschwindigkeit (PWV), Mikroalbuminurie, einige biochemische Parameter und Adipokine.

Ergebnisse

Zwischen den 2 Gruppen fanden wir statistisch signifikante Unterschiede für das HDL-Cholesterin, LDL-Cholesterin, die Triglyceride, das Insulin, die Harnsäure, den Blutzucker, das Aplipoprotein A1 und das Gesamt-Adiponectin. Die Mittelwerte (Durchschnittswerte) von IMT, PWV und LVM waren höher bei hypertensiven Kindern, aber nur die Unterschiede von IMT und LVM waren statistisch bedeutsam. Außerdem zeigten die hypertensiven Kinder signifikant höhere Werte vom AoSP (systolischer Druck in der Aorta), AoPP(Pulsdruck in der Aorta), und Alx@75 (Augmentations-Index adaptiert an die Herzfrequenz von 75/min). Das metabolische Syndrom haben wir bei 31% der hypertensiven Kinder diagnostiziert.

Schlussfolgerung

Eine signifikante Anzahl von Kindern mit EH, insbesondere die Übergewichtigen, haben frühe Endorganschäden sowie auch andere Risikofaktoren einschließlich des Metabolischen Syndroms. Allerdings haben sich IMT, LVM und einige Parameter der Arteriensteifigkeit als frühe Zeichen in beiden Gruppen, sowohl bei den Übergewichtigen, als auch bei Kindern mit Normalgewicht, erwiesen. Des Weiteren scheinen bei hypertensiven Übergewichtigen Adipokine und Gerinnungsfaktoren von Bedeutung zu sein.

Key words

adipokines - essential hypertension - intima-media thickness - left ventricular hypertrophy - pulse wave velocity

Schlüsselwörter

Adipokine - essentielle Hypertonie - Intima-Media-Dicke - linksventrikuläre Hypertrophie - Pulswellengeschwindigkeit

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