Raina Rupesh, Khooblall Amrit, Shah Raghav, Vijayvargiya Nina, Khooblall Prajit, Sharma Bhavya, Datla Nikhil, Narang Aarushi, Yerigeri Keval, Melachuri Manasa, Kusumi Kirsten
Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH 44307, USA.
Department of Nephrology, Akron Children's Hospital, Akron, OH 44308, USA.
Rev Cardiovasc Med. 2022 May 7;23(5):166. doi: 10.31083/j.rcm2305166. eCollection 2022 May.
Hypertension is one of the most prevalent diseases in the United States, affecting an estimated 3.5% of children and adolescents. It can be adversely affect most organ systems but is particularly detrimental to the heart and vascular systems. The repercussions can be gauged through well-established measures of cardiovascular function including left ventricular mass index (LVMI), left ventricular hypertrophy (LVH), carotid intima media thickness (cIMT), and aortic stiffness. Cardiovascular function is also affected by underlying etiologies of hypertension including chronic kidney disease, polycystic kidney disease, coarctation of the aorta, adrenal disorders, renal artery stenosis, obstructive sleep apnea, as well as various drugs and medications (decongestants, stimulants, Non-steroidal Anti-inflammatory Drugs (NSAIDs), and steroids).
An exhaustive literature search was conducted for clinical data regarding pediatric hypertension. Sixty-seven articles were incorporated with data on 189,477 subjects total. The data was then extracted and categorized as relating to hypertension incidence, LVMI, LVH, cIMT, and/or aortic stiffness.
The prevalence of pediatric ( 18 years) hypertension extracted from 47 studies from 1994 to 2018 averaged 4%. The LVMI assessed over 7 studies (n = 661) averaged 39.3 g/ in the hypertensive cohort and 30.1 g/ in the control cohort. The cIMT assessed over 7 studies (n = 580) averaged 0.55 mm in the hypertensive cohort and 0.49 mm in the control cohort. Ambulatory arterial stiffness parameters assessed over 5 studies (n = 573) in the normotensive cohort averaged 99.73 mmHg, 69.81 mmHg, 76.85 mmHg, and 46.90 mmHg, for SBP, DBP, MAP, and PP respectively. Ambulatory arterial stiffness parameters assessed over 5 studies (n = 573) in the hypertensive cohort averaged 129.56 mmHg, 73.69 mmHg, 95.08 mmHg, and 56.80 mmHg, for SBP, DBP, MAP, and PP respectively.
The significance of pediatric hypertension is emphasized by evidence of early cardiovascular disease as demonstrated by non-invasive measures including cIMT and arterial stiffness parameters, and target organ damage and including LVH and LVMI factors. Thus, early diagnosis and treatment of high blood pressure is paramount for improving long term cardiovascular health and preventing long term morbidity and mortality.
高血压是美国最常见的疾病之一，估计影响3.5%的儿童和青少年。它会对大多数器官系统产生不利影响，但对心脏和血管系统尤其有害。可以通过包括左心室质量指数（LVMI）、左心室肥厚（LVH）、颈动脉内膜中层厚度（cIMT）和主动脉僵硬度等成熟的心血管功能指标来衡量其影响。心血管功能还受到高血压潜在病因的影响，包括慢性肾病、多囊肾病、主动脉缩窄、肾上腺疾病、肾动脉狭窄、阻塞性睡眠呼吸暂停以及各种药物（减充血剂、兴奋剂、非甾体抗炎药（NSAIDs）和类固醇）。
对有关儿童高血压的临床数据进行了详尽的文献检索。纳入了67篇文章，总共涉及189477名受试者的数据。然后提取数据并分类为与高血压发病率、LVMI、LVH、cIMT和/或主动脉僵硬度相关的数据。
从1994年至2018年的47项研究中提取的儿科（≤18岁）高血压患病率平均为4%。在7项研究（n = 661）中评估的LVMI在高血压队列中平均为39.3 g/m²，在对照组中为30.1 g/m²。在7项研究（n = 580）中评估的cIMT在高血压队列中平均为0.55 mm，在对照组中为0.49 mm。在5项研究（n = 573）中评估的正常血压队列的动态动脉僵硬度参数，收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和脉压（PP）分别平均为99.73 mmHg、69.81 mmHg、76.85 mmHg和46.90 mmHg。在5项研究（n = 573）中评估的高血压队列的动态动脉僵硬度参数，SBP、DBP、MAP和PP分别平均为129.56 mmHg、73.69 mmHg、95.08 mmHg和56.80 mmHg。
通过cIMT和动脉僵硬度参数等非侵入性测量以及包括LVH和LVMI因素在内的靶器官损伤所证明的早期心血管疾病证据，强调了儿童高血压的重要性。因此，早期诊断和治疗高血压对于改善长期心血管健康以及预防长期发病和死亡至关重要。
