Predicting the risk of left ventricular hypertrophy in children and adolescents with arterial hypertension on the basis of 24-hour blood pressure monitoring and metabolism indicators

Tamara Haiduk; Olha Haiduk; Irene  Gubar

doi:10.36013/jimsa.v1i1.16

Tamara Haiduk Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine
Olha Haiduk Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine
Irene Gubar Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine

DOI: https://doi.org/10.36013/jimsa.v1i1.16

Keywords: Arterial hypertension, blood pressure monitoring, left ventricular hypertrophy, children

Abstract

Abstract: Objective: To investigate the significance of 24-hr ambulatory blood pressure monitoring (ABPM) data and metabolism indicators, as well their correlation in predicting the risk of left ventricular hypertrophy (LVH) in children and adolescents with arterial hypertension (AH).

Methods: We studied 118 children and adolescents, M±m 15.51±0.25 yrs, Boys/Girls – 104/14, with AH: 60 stable, 40 labile, 18 prehypertension (high-normal blood pressure), and a control group of 13 normotensive children, M±m 15,19±0,41 yrs, Boys/Girls – 10/3. All patients underwent a comprehensive anamnestic, clinical, laboratory, and instrumental examination, including 24-hr ABPM; indicators were standardized by gender and age. On Doppler echocardiography (echoCG), the left ventricular myocardial mass index (LVMI) was calculated. Lipid spectrum parameters were determined by biochemical method, venous blood glycemia by GOD-PAP, blood serum basal immunoreactive insulin by ELISA methods, insulin resistance (IR) by HOMA parameters calculation. Statistical processing was performed using the package of statistical analysis software STATISTICA.

Results: Of a range of metabolism indicators, BMI, TG level, LDL/HDL ratio, HOMA index, 24-hr DBP index, and the stable character of AH identified as the most significant factors in predicting the risk of LVH in hypertensive children. All multivariate models of logistic regressions, which include BMI, can predict the probability of LVH with an accuracy of 79.7-84.7%, sensitivity - 57.5-77.5%, specificity - 86.4-91.0%.

Conclusions: Obtained satisfactory concordance of the actual data with predictive models' results indicate the possibility of their use to predict the risk of LVH in children and adolescents with AH.

References

REFERENCES:

Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-1357. doi:10.1161/HYPERTENSIONAHA.120.15026.

Williams B, Mancia G, Spiering W, et al. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC task force for the management of arterial hypertension. J Hypertens. 2018;36(12):2284-2309. doi:10.1097/HJH.0000000000001961.

Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887-1920. doi:10.1097/HJH.0000000000001039.

Kavey RE. Left ventricular hypertrophy in hypertensive children and adolescents: predictors and prevalence. Curr Hypertens Rep. 2013;15(5):453-457. doi:10.1007/s11906-013-0370-3.

Stergiou GS, Parati G, Vlachopoulos C, et al. Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability. J Hypertens. 2016;34(9):1665-1677. doi:10.1097/HJH.0000000000000969.

Hamdani G, Flynn JT, Becker RC, et al. Prediction of ambulatory hypertension based on clinic blood

pressure percentile in adolescents. Hypertension. 2018;72(4):955-961. doi:10.1161/HYPERTENSIONAHA.118.11530.

Woroniecki RP, Kahnauth A, Panesar LE, Supe-Markovina K. Left ventricular hypertrophy in pediatric hypertension: A mini review. Front Pediatr. 2017;5:101. doi:10.3389/fped.2017.00101.

Mahgerefteh J, Linder J, Silver EJ, et al. The prevalence of left ventricular hypertrophy in obese children varies depending on the method utilized to determine left ventricular mass. Pediatr Cardiol. 2016;37(6):993-1002. doi:10.1007/s00246-016-1380-0.

Kollias A, Dafni M, Poulidakis E, Ntineri A, Stergiou GS. Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis. J Hypertens. 2014;32(12):2315-2331. doi:10.1097/HJH.0000000000000384.

Jing L, Nevius CD, Friday CM, et al. Ambulatory systolic blood pressure and obesity are independently associated with left ventricular hypertrophic remodeling in children. J Cardiovasc Magn Reson. 2017;19(1):86. doi:10.1186/s12968-017-0401-3.

Marcon D, Tagetti A, Fava C. Subclinical organ damage in children and adolescents with hypertension: Current guidelines and beyond. High Blood Press Cardiovasc Prev. 2019;26(5):361-373. doi:10.1007/s40292-019-00345-1.

Urbina EM, Khoury PR, McCoy C, Daniels SR, Kimball TR, Dolan LM. Cardiac and vascular consequences of pre-hypertension in youth. J Clin Hypertens (Greenwich). 2011;13(5):332-42. doi: 10.1111/j.1751-7176.2011.00471.x.

Genovesi S, Antolini L, Orlando A, et al. Cardiovascular risk factors associated with the metabolically healthy obese (MHO) phenotype compared to the metabolically unhealthy obese (MUO) phenotype in children. Front Endocrinol (Lausanne). 2020;11:27. doi:10.3389/fendo.2020.00027.

Cortese F, Cecere A, Maria Cortese A, et al. Vascular, cardiac and renal target organ damage associated to arterial hypertension: which noninvasive tools for detection?. J Hum Hypertens. 2020;34(6):420-431. doi:10.1038/s41371-020-0307-7.

Lurbe E, Torró I, Álvarez J, et al. Impact of ESH and AAP hypertension guidelines for children and adolescents on office and ambulatory blood pressure-based classifications. J Hypertens. 2019;37(12):2414-2421. doi:10.1097/HJH.0000000000002229.

Sharma AP, Mohammed J, Thomas B, Lansdell N, Norozi K, Filler G. Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension. Pediatr Nephrol. 2013;28(8):1275-1282. doi:10.1007/s00467-013-2468-x.

Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension. 2002;39(4):903-908. doi:10.1161/01.hyp.0000013266.40320.3b.

Maidannyk VG, Moskalenko VF, Eds. Pervynna arterial`na hipertenziya u ditej ta pidlitkiv [Primary hypertension in children and adolescents]. Kyiv; 2007.

Díaz A, Zócalo Y, Bia D. Reference intervals and percentile curves of echocardiographic left ventricular mass, relative wall thickness and ejection fraction in healthy children and adolescents. Pediatr Cardiol. 2019;40(2):283-301. doi:10.1007/s00246-018-2000-y.

Krysztofiak H, Młyńczak M, Małek ŁA, Folga A, Braksator W. Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method. PLoS One. 2019;14(11):e0225287. doi:10.1371/journal.pone.0225287.

Weihe P, Weihrauch-Blüher S. Metabolic syndrome in children and adolescents: diagnostic criteria, therapeutic options and perspectives. Curr Obes Rep. 2019;8(4):472-479. doi:10.1007/s13679-019-00357-x.

Genoni G, Menegon V, Secco GG, et al. Insulin resistance, serum uric acid and metabolic syndrome are linked to cardiovascular dysfunction in pediatric obesity. Int J Cardiol. 2017;249:366-371. doi:10.1016/j.ijcard.2017.09.031.

Trevethan R. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health. 2017;5:307. doi:10.3389/fpubh.2017.00307.