Anatol J Cardiol. Ahead of Print: AJC-67927

Could arterial stiffness be early reversible target organ damage test in childhood hypertension?

Duygu Övünç Hacýhamdioðlu¹, Ozben Ceylan², Aytul Hande Yardimci^3
1Bahçeþehir University Medicine Faculties
²University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital
³University of Health Sciences Istanbul Training and Research Hospital

Objective: The recommended treatment for the management of hypertension (HTN) in children has been revised recently. This study is to present the changes of target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary hypertension (HTN) who were managed in accordance with the European Society of Hypertension Guidelines 2016 (ESHG16).
Methods: The primary hypertension patients included in the study were newly diagnosed and untreated ones and they had a follow-up period of minimum 6 months. HTN was confirmed by 24-hour ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: Anthropometrical measurements of Body Mass Index (BMI), carotid intima media thickess (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, first morning urine albumin: creatinine ratio. The ABPM device was able to perform measurements like central blood pressure (cBP) and pulse wave velocity (PWV).
Results: Thirty-two of 104 patients were enrolled. Seventeen of the patients were male and the frequency of obesity was 53%. Compared with pretreatment, creatinine, urea, systolic blood pressure (SBP), diastolic blood pressure (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z-score, cDBP, and PWV z-score decreased, whereas LVMI z-score and BMI z score were not changed.
Conclusion: After the BP improved, while LVMI have not regressed yet, the cSBP, cSBP z score and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of blood pressure control on the cardiovascular system even in short-term follow-up. Further longitudinal studies are needed for assessment of BP control on arterial stifness in childhood.

Keywords: hypertension, children, left ventricular hypertrophy, arterial stiffness

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Çocukluk çaðý hipertansiyonunda arteriyel sertlik erken geri dönüþümlü hedef organ hasarý testi olabilir mi?

Duygu Övünç Hacýhamdioðlu¹, Ozben Ceylan², Aytul Hande Yardimci^3
1Bahçeþehir Üniversitesi Týp Fakültesi
²Saðlýk Bilimleri Üniversitesi Süleymaniye Kadýn Doðum ve Çocuk Hastalýklarý Hastanesi
³Saðlýk Bilimleri Üniversitesi Ýstanbul Eðitim ve Araþtýrma Hastanesi

Amaç: Çocuklarda hipertansiyon (HTN) yönetimi yakýn zamanda güncellenmiþtir. Bu çalýþma, Avrupa Hipertansiyon Derneði 2016 Kýlavuzuna göre yönetilen primer hipertansiyonlu çocuklarda tedavi sonrasý hedef organ hasarý ve arteriyel sertlik parametrelerindeki deðiþiklikleri sunmaktýr.
Yöntem: Çalýþmaya dahil edilen primer HTN hastalarý yeni taný almýþ ve tedavi edilmemiþ olup minimum 6 aylýk takip süreleri vardý. HTN 24 saatlik ayaktan kan basýncý monitörizasyonu (AKBM) ile doðrulanmýþtýr. Tüm hastalara takip eden deðerlendirmeler yapýldý; vücut kitle indeksi (VKÝ), karotis intima media kalýnlýðý (cIMT), sol ventrikül kitle indeksi (LVMI), plazma kreatinin, üre, elektrolitler, ürik asit, açlýk glukoz, kan lipitleri, idrar tetkiki, idrar kültürü, sabah ilk idrardan albumin: kreatinin oraný. AKBM cihazý, santral kan basýncý (cKB) ve nabzý dalga hýzý (PWV) gibi ölçümler yapabilmektedir.
Bulgular: Yüz dört hastadan 32’si (17 erkek) çalýþmaya alýndý. Hastalarýn 17’si erkekti ve obezite sýklýðý %53 idi. Tedavi öncesi ile karþýlaþtýrýldýðýnda kreatinin, üre, sistolik kan basýncý (SKB), diyastolik kan basýncý (DKB), sistolik yük, diyastolik yük, santral sistolik kan basýncý (sSKB), sSKB z-skoru, sDKB ve PWV z-skoru azalýrken, LVMI z-skoru ve VKÝ z skoru deðiþmedi.
Sonuç: Kan basýncý düzeldikten sonra henüz LVMI gerilememiþken arteriyel sertliðin belirteçleri olan sSKB, cSKB z skoru ve PWV z skor deðerleri geriledi. Bu, kýsa süreli takipte bile kan basýncý kontrolünün kardiyovasküler sistem üzerindeki düzeltici etkisini desteklemektedir. Çocukluk çaðýnda kan basýncý kontrolünün arteriyel sertliðe etkisini için daha fazla prospektif çalýþmalara ihtiyaç vardýr.

Anahtar Kelimeler: hipertansiyon, çocuk, sol ventrikül hipertrofisi, arteriyel sertlik

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