Anatol J Cardiol. 2021; 25(7): 496-504 | DOI: 10.5152/AnatolJCardiol.2021.67927

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

Duygu Övünç Hacýhamdioðlu¹, Özben Ceylan², Aytül Hande Yardýmcý^3
1Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Bahçeþehir University, Medical Park Göztepe Hospital; Ýstanbul-Turkey;Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital; Ýstanbul-Turkey
²Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital; Ýstanbul-Turkey;Department of Pediatric Cardiology, University of Health Sciences, Ýstanbul Training and Research Hospital; Ýstanbul-Turkey
³Department of Radiology, University of Health Sciences, Ýstanbul Training and Research Hospital; Ýstanbul-Turkey

Objective: The recommended treatment for hypertension (HTN) in children has been revised recently. This study aimed to present the changes in target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary HTN who were managed in accordance with the 2016 European Society of Hypertension Guidelines.
Methods: Patients with primary HTN included in this study were newly diagnosed, untreated, and were followed-up for a minimum of 6 months. HTN was confirmed by 24-h ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, and first morning urine albumin tocreatinine ratio. The ABPM device performed measurements such as central blood pressure (cBP) and pulse wave velocity (PWV).
Results: Thirty-two of 104 patients were enrolled. Seventeen patients were male, and 53% were obese. Compared with pretreatment, creatinine, urea, systolic BP (SBP), diastolic BP (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z score, cDBP, and PWV z score decreased, whereas LVMI and BMI z scores were unchanged.
Conclusion: After BP improvement, while LVMI did not regress, the cSBP, cSBP z, and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of BP control on the cardiovascular system even in a short-term follow-up. Further longitudinal studies are needed for the assessment of BP control on arterial stiffness 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, Özben Ceylan², Aytül Hande Yardýmcý^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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