Haemodynamics of Hypertension in Children
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BLOOD PRESSURE MONITORING AND MANAGEMENT (J COCKCROFT, SECTION EDITOR)
Haemodynamics of Hypertension in Children Ye Li 1,2 & Emily Haseler 3 & Phil Chowienczyk 1,2 & Manish D. Sinha 1,3
# The Author(s) 2020
Abstract Purpose of Review To review the haemodynamic characteristics of paediatric hypertension. Recent Findings Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Summary Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children. Keywords Blood pressure . Cardiac output . Haemodynamics . Hypertension . Arterial stiffness
Introduction Hypertension in the adult population is the leading cause of cardiovascular morbidity and has been estimated as responsible for one third of ischaemic heart disease and two thirds of stroke [1]. Hypertension in older adults is thought to be primarily due to a degenerative vascular ageing process leading to stiffening of the large arteries and possibly other haemodynamic effects [2]. The aetiology of primary hypertension in children and young people is less well understood. Hypertension in the paediatric population is becoming more prevalent, mainly due to the increasing prevalence of obesity. Longitudinal studies have shown that children with hypertension are likely to become hypertensive adults with an elevated cardiovascular risk [3]. This review aims to summarize what is currently known regarding the haemodynamic mechanisms Ye Li and Emily Haseler contributed equally to this review. This article is part of the Topical Collection on Blood Pressure Monitoring and Management * Phil Chowienczyk [email protected] 1
King’s College London British Heart Foundation Centre, London, UK
2
Department of Clinical Pharmacology, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK
3
Department of Pediatric Nephrology, Evelina London Children’s Hospital, London, UK
underlying paediatric hypertension and suggest directions for future research in the area.
Definition and Prevalence of Hypertension in the Paediatric Population There is no consensus from longitudinal data regarding what degree of elevation in systolic and diastolic blood pressure is associated with end organ damage and adverse cardiovascular outcomes in children. Paediatric hypertension is therefore diagnosed using a statistical definition of either mean systolic blood pressure (SBP) or mean diastolic blood pressure (DBP), measured on at least 3 separate occasions, above the 95th percentile for height, gender and age of a reference population [4]. The prevalence of hypertension thus varies according to characteristics of the local population and has been found to be between 2.2% - 13% in recent r
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