Sathik Nafees, Safadi Rama, Saini Ishveen, Ahuja Arsheya, Hu Jieji, Raina Rupesh
College of Graduate Studies, Northeast Ohio Medical University, Rootstown, OH 44272, USA.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA.
Rev Cardiovasc Med. 2025 Aug 25;26(8):39498. doi: 10.31083/RCM39498. eCollection 2025 Aug.
Cardiovascular assessments in children and adolescents with hypertension are essential for detecting early signs of organ damage and guiding timely interventions. The pathophysiology of pediatric hypertension involves a complex interplay of arterial stiffness, endothelial dysfunction, metabolic disturbances, activation of the renin-angiotensin-aldosterone system, and immune dysregulation. These mechanisms collectively contribute to target organ damage, particularly in the cardiovascular system. Traditional office-based blood pressure measurements often fail to identify individuals at high risk, prompting the adoption of more advanced diagnostic techniques. Measures of arterial stiffness, such as pulse wave velocity, augmentation index, and cardio-ankle vascular index, provide valuable insights into vascular health and have been strongly associated with left ventricular hypertrophy and impaired heart function. Imaging modalities, including carotid intima-media thickness and epicardial adipose tissue measurements, serve as indicators of subclinical atherosclerosis and cardiovascular risk. Advanced echocardiographic tools that assess myocardial strain and ventricular-arterial coupling provide a more nuanced understanding of cardiac performance in hypertensive adolescents. These advanced techniques enhance the early detection of cardiovascular abnormalities and support a more individualized approach to managing pediatric hypertension. However, challenges related to validation, standardization, and clinical integration remain. Thus, expanding access to these modalities and refining their use in pediatric populations are crucial steps toward improving long-term cardiovascular outcomes in youth with elevated blood pressure.
对患有高血压的儿童和青少年进行心血管评估对于检测器官损伤的早期迹象和指导及时干预至关重要。儿童高血压的病理生理学涉及动脉僵硬度、内皮功能障碍、代谢紊乱、肾素 - 血管紧张素 - 醛固酮系统激活和免疫失调之间的复杂相互作用。这些机制共同导致靶器官损伤，尤其是在心血管系统中。传统的基于诊室的血压测量往往无法识别高危个体，这促使人们采用更先进的诊断技术。动脉僵硬度的测量指标，如脉搏波速度、增强指数和心踝血管指数，为血管健康提供了有价值的见解，并与左心室肥厚和心脏功能受损密切相关。成像方式，包括颈动脉内膜中层厚度和心外膜脂肪组织测量，可作为亚临床动脉粥样硬化和心血管风险的指标。评估心肌应变和心室 - 动脉耦合的先进超声心动图工具能更细致地了解高血压青少年的心脏功能。这些先进技术有助于早期发现心血管异常，并支持采用更个性化的方法来管理儿童高血压。然而，与验证、标准化和临床整合相关的挑战仍然存在。因此，扩大这些检查手段的可及性并优化其在儿科人群中的应用，是改善血压升高青少年长期心血管结局的关键步骤。
