Abnormalities of vascular structure and function in pediatric hypertension

Abstract

Hypertension is associated with adverse cardiovascular (CV) events in adults. Measures of vascular structure and function, including increased carotid intima-media thickness (cIMT) and elevated arterial stiffness predict hard CV events in adulthood. Newer data suggest that abnormalities in target organ damage are occurring in adolescents and young adults with high blood pressure. In this review, we discuss the techniques for measuring vascular dysfunction in young people and the evidence linking blood pressure levels to this type of target organ damage.

Keywords: Arterial stiffness; Carotid artery; Hypertension; Pediatric.

Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

Figure 1

Increased carotid thickness in pediatric patients with chronic kidney disease (CKD). P≤0.05 *Compared to normal; †Compared to chronic renal insufficiency; N=93, mean age 14 years [22].

Figure 2

Carotid B-mode and M-mode ultrasound for measurement of carotid stiffness.

Figure 3

Decline in brachial artery distensibility with increasing systolic blood pressure (SBP) [17]. R2 = 0.27, p≤0.001; solid line = mean, dotted lines = 95% confidence intervals.

Figure 4

Higher pulse wave velocity (PWV) in youth with chronic kidney disease (CKD) [33]. *P≤0.05 for difference among groups.

Figure 5

Elevated augmentation index (AIx) in children with chronic kidney disease (CKD). N=62, mean age 15 years [45].

Figure 6

Relationship between arterial stiffness and left verntricular mass (LVM) index (mean and 95% confidence interval). R2 = 0.52; P for slope differs from zero ≤0001. N=670, mean age 18 years. Reproduced from [69], used with permission.

Figure 7

Improved flow-mediated dilation (FMD) in youth with hypertension (HTN) after 6 months of DASH-4-Teens Diet, p=0.05. N=64, mean age 15 years.