Effects of Childhood Primary Hypertension on Carotid Intima Media Thickness A Matched Controlled Study

Department of Pediatrics, University of Rochester, Rochester, New York, United States
Hypertension (Impact Factor: 6.48). 07/2006; 48(1):40-4. DOI: 10.1161/01.HYP.0000227029.10536.e8
Source: PubMed


To determine whether carotid intima media thickness is increased in children with primary hypertension, the current study compared carotid intima media thickness in hypertensive children with that of normotensive control subjects matched closely for body mass index and determined the relationship between carotid intima media thickness and hypertension severity determined by ambulatory blood pressure monitoring. Children with newly diagnosed office hypertension (n=28) had carotid intima media thickness, left ventricular mass index, and ambulatory blood pressure monitoring performed. Carotid intima media thickness was performed in normotensive control subjects (n=28) matched pairwise to hypertensive subjects for age (+/-1 year), gender, and body mass index (+/-10%). Eighty-two percent of subjects were overweight or obese (body mass index > or =85th percentile). The median carotid intima media thickness of hypertensive subjects was greater than that of matched controls (0.67 versus 0.63 mm; P=0.045). In the hypertensive subjects, carotid intima media thickness correlated strongly with several ambulatory blood pressure monitoring parameters, with the strongest correlation for daytime systolic blood pressure index (r=0.57; P=0.003). In the hypertensive group, the prevalence of left ventricular hypertrophy was 32%, but unlike carotid intima media thickness, left ventricular mass index did not correlate with ambulatory blood pressure monitoring. Together, the findings that hypertensive subjects had increased carotid intima media thickness compared with matched controls and that higher carotid intima media thickness correlated with more severe hypertension by ambulatory blood pressure monitoring provide strong evidence that carotid intima media thickness is increased in childhood primary hypertension, independent of the effects of obesity.

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Available from: Jason Roy, Dec 14, 2013
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    • "CVD is characterized by a silent phase, the onset of which occurs before clinical manifestation, possibly in early childhood [3]. Children with known CVD risk factors such as familial hypercholesterolemia [4], hypertension [5], obesity [6], metabolic syndrome [7], and type 1 diabetes [8] are known to have increased cIMT. Functional impairment can be observed even earlier than this morphological alteration of the arterial wall [3]. "
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    ABSTRACT: Subclinical atherosclerosis can be assessed via sonographic measurement of intima-media thickness and carotid artery distensibility, both may already be pathologically altered in childhood. Therefore, the purpose of this study was to provide reference percentiles and investigate possible associations between alterations of intima-media thickness and distensibility. Carotid intima-media thickness and distensibility was measured via B- and M-mode ultrasound. Distensibility was defined by arterial compliance, elastic modulus, stiffness parameter β, and local pulse wave velocity β. Age- and height-dependent reference values were calculated separately for boys and girls among 690 (intima-media thickness) and 870 (distensibility) non-obese children aged 7-17 years. Intima-media thickness and distensibility did not increase significantly with age or differ between boys and girls. Systolic blood pressure and body mass index were independent predictors of intima-media thickness, while an increased systolic blood pressure or pulse pressure was associated with stiffer arteries. Increased intima-media thickness was accompanied by higher arterial compliance and lower stiffness. Using this healthy cohort, we describe a functional and non-pathological arterial adaptation wherein an increase in intima-media thickness is not associated with stiffer arteries. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 07/2015; 242(1):48-55. DOI:10.1016/j.atherosclerosis.2015.06.045 · 3.99 Impact Factor
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    • "Elevated BP in childhood may predispose to left ventricular hypertrophy and increased arterial stiffness [5] [6], which then predispose to incident cardiovascular events in young adults [7] [8]. Moreover, some studies suggested that elevated childhood BP might be associated with cardiovascular remodeling from as early as childhood [9] [10]. "
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    ABSTRACT: There are few studies investigating the long-term association between childhood blood pressure (BP) and adult cardiovascular remodeling. We seek to examine the effect of elevated childhood BP on cardiovascular remodeling in early or middle adulthood. We used the "Beijing BP Cohort Study", where 1259 subjects aged 6-18years old were followed over 24years from childhood (1987) to early or middle adulthood (2011). Anthropometric measures and BP were obtained at baseline and follow-up examinations. Carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured to assess cardiovascular remodeling in early or middle adulthood. Multiple logistic regression models were used to assess the odds ratio (OR) and 95% confidence interval (CI) for cardiovascular remodeling. 82 out of 384 children with elevated BP (21.4%) had adult hypertension. Compared to those with normal BP, children with elevated BP were at 2.1 times (95% CI: 1.4-3.1) likely to develop hypertension in early or middle adulthood. Compared to those with normal BP, children with elevated BP were at higher OR of developing high cfPWV (OR=1.8, 95% CI=1.3-2.4), high cIMT (1.4, 1.0-1.9), or high LVMI (1.4, 1.0-1.9) in early or middle adulthood. The ORs for remodeling (for any measures) were 1.4 (0.9-2.0) in early adulthood for children age 6-11years, and 1.6 (1.1-2.4) in middle adulthood for those aged 12-18years. Children with elevated BP from 6years old have accelerated remodeling on both cardiac and arterial system in early or middle adulthood. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 11/2014; 177(3):836-839. DOI:10.1016/j.ijcard.2014.11.013 · 4.04 Impact Factor
    • "Hypertension is a major risk factor for CVDs and has its roots in childhood.[345] Pediatric hypertension is also known to cause long-term cardiovascular morbidity and interferes with cognitive function.[678910] Childhood overweight and obesity are known to increase the risk of cardiovascular morbidity, irrespective of whether obesity persists into adulthood.[11121314] "
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    ABSTRACT: Little is known about the relationship of blood pressure (BP) with adiposity indicators, dietary habits, physical activity, and sleep in school children in Malaysia. We aimed to study about the distribution of BP and its associated factors in primary school children. A survey was carried out on a random sample of 335 children in five primary schools. BP was measured with a mercury sphygmomanometer. Anthropometry was done by standard methods. Demographic information, dietary habits, physical activity, and duration of sleep were collected by interviews. World Health Organization classification based on body mass index (BMI) and waist circumference (WC) cut-offs were used to define overweight/obesity. Elevated BP was defined according to US reference standards. A total 335 children (144 boys and 191 girls) were examined. Their mean age was 9.18 years (standard deviation [SD] = 0.28). Overall mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) were 99.32 mmHg (SD = 10.79) and 67.11 mmHg (SD = 10.76), respectively. Mean BMI and WC were 16.39 (SD = 3.58) and 57.77 cm (SD = 8.98), respectively. The prevalence of pre-hypertension was 12.23% (95% confidence intervals [CIs] 8.73, 15.75) and hypertension was 13.4% (95% CIs 9.78, 17.09). Mean SBP and DBP was higher among overweight and obese children than normal children. By multivariate linear regression analyses, BMI (β = 0.250, P = 0.049) and WC (β = 0.308, P = 0.015) were positively associated with SBP; age (β = 0.111, P = 0.017), BMI (β = 0.320, P = 0.012) were positively associated with DBP but total (weekly) hours of sleep (β = -0.095, P = 0.037) was negatively associated with DBP. BP was associated with BMI and WC. Health promotion activities should be initiated in primary schools.
    05/2013; 20(2):90-7. DOI:10.4103/2230-8229.114769
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