Woroniecki Robert P, Kahnauth Andrew, Panesar Laurie E, Supe-Markovina Katarina
Division of Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA.
Stony Brook University, Stony Brook, NY, USA.
Front Pediatr. 2017 May 11;5:101. doi: 10.3389/fped.2017.00101. eCollection 2017.
Adults with arterial hypertension (HTN) have stroke, myocardial infarction, end-stage renal disease (ESRD), or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes "hard outcomes" observed in adults. Left ventricular hypertrophy (LVH) or an anatomic and pathologic increase in left ventricular mass (LVM) in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered "the gold standard" for LVM and LVH determination, pediatric data are limited to "special populations": ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.
患有动脉高血压（HTN）的成年人发生中风、心肌梗死、终末期肾病（ESRD）或死亡的几率高于未患高血压的成年人。在儿童中，高血压会导致靶器官损害，包括肾脏、大脑、眼睛、血管和心脏，这些损害先于在成年人中观察到的“严重后果”。左心室肥厚（LVH）或因高血压导致的左心室质量（LVM）在解剖学和病理学上的增加，是儿童高血压在成人中导致发病和死亡的替代标志物。这篇小型综述讨论了当前的定义、LVM测量的临床相关方法和标准化方法、其流行病学、管理以及高血压儿童中LVM的可逆性问题。儿童LVH和异常LVM的定义并不统一。由于定义多样，儿童高血压所致LVH的患病率难以确定。此外，虽然在成年人中，心脏磁共振成像被认为是LVM和LVH测定的“金标准”，但儿科数据仅限于“特殊人群”：ESRD患者、移植患者和肥胖儿童。我们总结了关于儿童LVH治疗和可逆性的现有数据，并为解决高血压儿童的LVH问题提供了未来方向。
