In newly diagnosed hypertensive children, increased arterial stiffness and reduced heart rate variability were associated with a non-dipping blood pressure pattern.

OBJECTIVES

This study was designed to investigate the differences in pulsatile hemodynamics, echocardiographic findings, 24-h Holter monitoring and heart rate variability parameters of dipper patterns in children with newly diagnosed essential hypertension.

METHODS

This study included 30 children with newly diagnosed essential hypertension and 30 healthy controls. The essential hypertension cohort was divided into dippers and non-dippers. Physical examinations, 24-hour ambulatory blood pressure monitoring, 24-h Holter monitoring, 24-h heart rate variability, conventional 2-dimensional and Doppler echocardiography, and tissue Doppler imaging were performed. Pulse wave analysis using an oscillometric monitor was conducted to measure augmentation index (AIx) and pulse wave velocity (PWV).

RESULTS

In patients with essential hypertension, left ventricular (LV) wall thickness and LV mass index were increased. There were no significant differences in LV mass index and LV wall thickness based on the dipping patterns. Time domain values and the standard deviation of all RR intervals (SDNN) were substantially lower in the essential hypertension group. SDNN values were considerably lower in the non-dipper group compared with the dipper group. In terms of frequency domain measures, low frequency measured in daytime values was much lower in the essential hypertension group compared with the control. The dipper patterns revealed that low frequency measured in nighttime values was also substantially lower in the non-dipper group. Pulse wave analysis and AIx values were notably higher in the essential hypertension patient group and those with non-dipper status.

CONCLUSION

SDNN values, which reflect parasympathetic activity, were markedly lower in children with hypertension and the non-dipper group than healthy controls and the dipper group, respectively. Also, parameters related to arterial stiffness, such as PWV and AIx values were significantly higher in children with hypertension and the non-dipper group.