Prognostic value of ambulatory blood pressure and clinical use of echocardiography to detect left ventricular hypertroph
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ORIGINAL ARTICLE
Prognostic value of ambulatory blood pressure and clinical use of echocardiography to detect left ventricular hypertrophy in children evaluated for primary hypertension Grace Truong 1 & Sarah Kamal 1 & Joshua A Samuels 1
&
Cynthia S Bell 1
Received: 24 July 2019 / Revised: 29 May 2020 / Accepted: 8 June 2020 # IPNA 2020
Abstract Background Hypertension (HTN) is common in children and often associated with pathologic progression to end organ damage, specifically left ventricular hypertrophy (LVH). Methods The primary goal of this retrospective chart review is to determine if patients with higher blood pressure were more likely to complete echocardiogram (ECHO) and more likely to have LVH, among a pediatric population referred for hypertension evaluation before the 2017 American Academy of Pediatrics (AAP) guidelines. To meet this goal, the number of patients evaluated by ECHO and prevalence of LVH was examined for independent associations with blood pressure and BMI categories by logistic regression. Results It was found that higher blood pressure was associated with having an ECHO evaluation (p = 0.012). Among patients evaluated by ECHO, one-third had LVH but the presence of LVH was not associated with blood pressure severity or use of antihypertensive medication. Instead, BMI was the only factor associated with LVH cardiac remodeling in our population (p = 0.025). Conclusions Newly updated AAP practice guidelines recommend evaluation of HTN via ABPM, with ECHO performed only at the initiation of pharmaceutical therapy. It is notable that BMI, the only risk factor of LVH found in this study, is not addressed in the current AAP guidelines for ECHO evaluation among hypertensive children. This study suggests that ECHO evaluation may be warranted in a larger subset of children as is recommended by current European Society of Hypertension pediatric guidelines. Keywords Pediatric . Hypertension . Ambulatory blood pressure . ECHO . Left ventricular hypertrophy . Obesity
Introduction High blood pressure is a major risk factor for mortality globally, accounting for 9.4 million deaths worldwide each year and responsible for nearly half of deaths due to heart disease and stroke [1]. Hypertension (HTN) is commonly detected in children, with a prevalence of 6–15% on initial measurement and 2–4% once confirmed on three separate occasions [2–4]. While children do not experience severe cardiovascular events like adults, chronic HTN causes increased cardiac muscle stiffness and thickening of chamber walls. This pathological remodeling
* Cynthia S Bell [email protected] 1
Division of Pediatric Nephrology & Hypertension, McGovern Medical School at University of Texas-Health, Houston, TX, USA
leads to left ventricular hypertrophy (LVH), a commonly seen indication of end organ damage in hypertensive youths [5]. Due to physiologic changes that occur in children as they mature, separate pediatric guidelines have been created for the management and evaluation of HTN in children. In 2017, the American Acade
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