Kos Martina, Nađ Tihana, Stupin Ana, Drenjančević Ines, Kolobarić Nikolina, Šušnjara Petar, Mihaljević Zrinka, Damašek Mia, Pušeljić Silvija, Jukić Ivana
Clinic of Pediatrics, University Hospital Centre Osijek.
Department of Pediatrics, Faculty of Medicine Osijek.
J Hypertens. 2024 Nov 1;42(11):1906-1914. doi: 10.1097/HJH.0000000000003812. Epub 2024 Jul 4.
Hypertension has become a global medical and public health issue even in childhood. It is well accepted that hypertension is associated with impaired endothelium-dependent vascular reactivity in adult patients. However, there is a lack of data on hypertension-related endothelial dysfunction in hypertensive children. Thus, present study aimed to evaluate the association of primary hypertension in the pediatric population with macro- and microvascular function, and to assess the potential role of oxidative stress in that connection.
Fifty-two children were enrolled in this study; 26 normotensive (NT) and 26 with primary hypertension (HT), both sexes, 9-17 years old. In addition to anthropometric, hemodynamic and biochemical measurements, peripheral microvascular responses to occlusion (postocclusive reactive hyperemia, PORH), local heating (local thermal hyperemia, LTH), iontophoretically applied acetylcholine (AChID) and sodium nitroprusside (SNPID) were evaluated by laser Doppler flowmetry (LDF). Furthermore, brachial artery flow-mediated dilation (FMD) was measured and biomarker of oxidative stress was determined.
PORH, AChID and LTH were impaired in hypertensive compared to normotensive children, while SNPID did not differ between groups. FMD was decreased in hypertensive compared to normotensive children. Serum concentration of 8- iso -PGF2α was significantly elevated in hypertensive compared to normotensive children.
Even in childhood, primary hypertension is associated with attenuated endothelial function and reduced endothelium-dependent responses to various physiological stimuli. Juvenile hypertension is related to increased level of vascular oxidative stress. All changes are independent of BMI.
即使在儿童期，高血压也已成为一个全球性的医学和公共卫生问题。人们普遍认为，高血压与成年患者内皮依赖性血管反应性受损有关。然而，关于高血压儿童中与高血压相关的内皮功能障碍的数据却很缺乏。因此，本研究旨在评估儿科人群中原发性高血压与大、微血管功能的关联，并评估氧化应激在这种关联中的潜在作用。
本研究纳入了52名儿童；26名血压正常（NT）儿童和26名原发性高血压（HT）儿童，年龄在9至17岁之间，涵盖了各个性别。除了进行人体测量、血流动力学和生化测量外，还通过激光多普勒血流仪（LDF）评估了外周微血管对闭塞（闭塞后反应性充血，PORH）、局部加热（局部热充血，LTH）、离子电渗法应用乙酰胆碱（AChID）和硝普钠（SNPID）的反应。此外，还测量了肱动脉血流介导的舒张功能（FMD）并测定了氧化应激生物标志物。
与血压正常的儿童相比，高血压儿童的PORH、AChID和LTH受损，而SNPID在两组之间没有差异。与血压正常的儿童相比，高血压儿童的FMD降低。与血压正常的儿童相比，高血压儿童血清中8-异前列腺素F2α（8-iso-PGF2α）的浓度显著升高。
即使在儿童期，原发性高血压也与内皮功能减弱以及对各种生理刺激的内皮依赖性反应降低有关。青少年高血压与血管氧化应激水平升高有关。所有这些变化均与体重指数（BMI）无关。
