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  • 1
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    Abstract P233: Blood Pressure Variability and Rhythmicity in Adolescents With Spurious Hypertension
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Hypertension Vol. 72, No. Suppl_1 ( 2018-09)
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 72, No. Suppl_1 ( 2018-09)
    Abstract: Objective: Spurious hypertension (sHTN) is characterized by elevated systolic blood pressure (BP) in peripheral arteries but normal central BP. The BP variability and characteristics of BP rhythms in sHTN is unknown. We therefore analyzed BP variability and rhythmicity in adolescents with sHTN in comparison with other forms of hypertension (HTN). Patients and Methods: We studied 265 children (54 girls; 15.1 ±2.5 years) referred with arterial HTN, in whom secondary HTN was excluded. We assessed BP levels - office BP, ABPM, central systolic BP (cSBP), systolic BP average real variability (SBPARV) and mean MAP rhythmicity (amplitudes and acrophases). Anova with TukeyHSD post hoc test was used to compare groups. One tailed t-test was used to compare MAP amplitudes and acrophases with normative values for children with Bonferroni correction for multiple tests. Results: 115 subjects had white coat hypertension (WCH; office BP 〉 95 th perc+ABPM 〈 95 th perc), 25 had ambulatory prehypertension (preHTN; office BP 〈 95 th perc+ABPM 〈 95 th perc+ABPM load 〉 25%), 43 had sHTN (office BP+ABPM 〉 95th perc+cSBP 〈 95 th perc), 82 had true hypertension (tHTN; office BP+ABPM+cSBP 〉 95th perc. There were no significant differences between groups in age, weight and BMI. The median SBPARV was 8.87 in WCH, 8.63 in preHTN, 9.25 in sHTN and 9.28 in tHTN (not significantly different between groups). The prevalence of 24h rhythms ranged from 77 to 88%, not significantly from norms or among groups. The prevalence of 12h rhythms was not significantly different compared to norms and ranged from 50 to 60% (NS among groups). There were also no significant differences in the prevalence of 8h and 6h rhythms. All groups had significantly decreased 24h amplitudes compared to norms, but not significantly different among groups. There were no differences in 12h, 8h and 6 amplitudes between WCH, preHTN, sHTH, tHTN and norms. 24h acrophases were significantly prolonged in sHTN, 12h acrophases were significantly prolonged in preHTN, sHTN and tHTN. Conclusions: Adolescents with spurious hypertension have significantly lower prevalence of 24h rhythms, decreased 24h amplitudes and prolonged 24h and 12h acrophases suggesting increased sympathetic drive similarly to patients with other hypertensive phenotypes.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/hyp.72.suppl_1.P233
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2094210-2
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  • 2
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    Stricter Blood Pressure Control Is Associated With Lower Left Ventricular Mass in Children After Kidney Transplantation: A Longitudinal Analysis of the 4C-T Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Hypertension Vol. 80, No. 9 ( 2023-09), p. 1900-1908
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    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 80, No. 9 ( 2023-09), p. 1900-1908
    Abstract: We assessed the effect of blood pressure (BP) control on left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH). METHODS: Ninety-six patients (64 males) ≥9 months post–kidney transplantation from the 4C-T (Cardiovascular Comorbidity in Children with Chronic Kidney Disease and Transplantation) study were analyzed longitudinally (mean follow-up, 2.6±1.3 years). Cumulative systolic blood pressure (SBP)/diastolic BP exposure was calculated as a time-averaged area under the curve and categorized: ≤50th, 50th to ≤75th, 75th to ≤90th, and 〉 90th percentile (pct). We performed adjusted linear and logistic mixed models for LVMI and LVH, respectively. RESULTS: At baseline, LVMI was 49.7±12.7g/m 2.16 with 64% (n=61) kidney transplantation recipients displaying LVH. Compared with patients with cumulative SBP exposure 〉 90th pct, patients with cumulative SBP of 50th to ≤75th showed a significant LVMI reduction of −5.24g/m 2.16 ( P =0.007). A similar tendency was seen for cumulative SBP≤50th (β=−3.70 g/m 2.16 ; P =0.067), but patients with cumulative SBP of 75th to ≤90th pct showed no reduction. A post hoc analysis in patients with cumulative SBP≤75th revealed that median SBP exposure was at 57.5th pct. For cumulative diastolic BP, a significant LVMI reduction was seen in all 3 categories ≤90th pct compared with patients 〉 90th pct. Patients with cumulative SBP of ≤50th or 50th to ≤75th pct showed 79% or 83% lower odds of developing LVH, respectively. Patients with cumulative diastolic BP ≤50th showed a tendency of 82% lower odds for LVH (95% CI, 0.03–1.07). CONCLUSIONS: Stricter BP control led to regression of LVMI and LVH. Our data suggest a BP target below the 60th pct, which needs to be substantiated in a randomized controlled trial.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.123.21187
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2094210-2
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  • 3
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    Remodeling of Retinal Microcirculation Is Associated With Subclinical Arterial Injury in Hypertensive Children
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Hypertension Vol. 77, No. 4 ( 2021-04), p. 1203-1211
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 77, No. 4 ( 2021-04), p. 1203-1211
    Abstract: The aim of the study was to assess the relationship between hypertensive target organ damage and vessel density (VD), foveal thickness, thickness of retinal nerve fiber layer, ganglion cell complex, and foveal avascular zone (FAZ) using optical coherence tomography angiography in a nonselected group of hypertensive children. One hundred fifty-seven children (56 girls) in mean age 14.9±2.9 years, in whom arterial hypertension was ultimately diagnosed were included in the study. FAZ, whole, fovea, parafovea superficial VD, whole, fovea, parafovea deep VD, foveal thickness, retinal nerve fiber layer, and ganglion cell complex were taken into analysis. Both absolute and standardized values of carotid intima-media thickness correlated with the larger FAZ area ( P =0.035, r =0.17; P =0.01, r =0.2, respectively). Subjects with increased carotid intima-media thickness had significantly larger FAZ ( P =0.024), reduced fovea superficial VD ( P =0.039), and foveal thickness ( P =0.007). Left ventricular hypertrophy and increased carotid-femoral pulse wave velocity were not associated with optical coherence tomography angiography parameters. Multiple linear regression revealed that the only determinant of FAZ and foveal thickness was higher carotid intima-media thickness–SD score, and for fovea superficial VD, the only determinant was central systolic blood pressure. In conclusion, hypertensive children present with signs of remodeling of microcirculation and decreased neural layer of retina associated with hypertensive macrocirculation remodeling expressed as increased carotid intima-media thickness and elevated central systolic blood pressure.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.120.16734
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2094210-2
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  • 4
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    Hemodynamic Patterns and Target Organ Damage in Adolescents With Ambulatory Prehypertension
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Hypertension Vol. 75, No. 3 ( 2020-03), p. 826-834
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 75, No. 3 ( 2020-03), p. 826-834
    Abstract: Although the importance of office prehypertension/high normal blood pressure (BP) has been well documented, the significance of ambulatory prehypertension (AmbPreHT) has not been determined. We analyzed markers of target organ damage and hemodynamics in adolescents with AmbPreHT in comparison with hypertensive and normotensive subjects. Out of 304 white patients aged 15.0±2.5 years with office hypertension, 30 children had AmbPreHT and were compared with 66 normotensive healthy children and 92 children with true hypertension (elevated office, ambulatory, and central BP), 22 had ambulatory hypertension (AmbHT), and 70 had severe AmbHT (SevAmbHT). Stroke volume and cardiac output were greater in AmbPreHT compared with patients with normotension but did not differ between AmbPreHT, AmbHT, and SevAmbHT. Similarly, AmbPreHT, AmbHT, and SevAmbHT had similar total peripheral resistance, lower than patients with normotension ( P 〈 0.05). Central systolic BP was higher in patients with AmbPreHT, AmbHT, and SevAmbHT compared with normotensives ( P 〈 0.01). In all 3 groups, the carotid intima-media thickness Z scores were significantly higher than in normotensive ( P 〈 0.001). AmbPreHT and AmbHT patients had higher left ventricular mass index and prevalence of left ventricular hypertrophy compared with normotensive but lower compared with SevAmbHT ( P 〈 0.001). Pulse wave velocity Z scores were increased in patients with AmbPreHT, AmbHT, and SevAmbHT compared with patients with normotension ( P 〈 0.01). Multiple regression analysis showed that body mass index Z score, central systolic BP, and uric acid levels were significant independent predictors of left ventricular mass index. In conclusion, patients with AmbPreHT presented similar cardiovascular adaptations to those observed in patients with hypertensive and may be at risk of developing cardiovascular events.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.119.14149
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2094210-2
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  • 5
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    Second and Third Generational Advances in Therapies of the Immune-Mediated Kidney Diseases in Children and Adolescents
    MDPI AG ; 2022
    In:  Children Vol. 9, No. 4 ( 2022-04-11), p. 536-
    Details
    In: Children, MDPI AG, Vol. 9, No. 4 ( 2022-04-11), p. 536-
    Abstract: Therapy of immune-mediated kidney diseases has evolved during recent decades from the non-specific use of corticosteroids and antiproliferative agents (like cyclophosphamide or azathioprine), towards the use of more specific drugs with measurable pharmacokinetics, like calcineurin inhibitors (cyclosporine A and tacrolimus) and mycophenolate mofetil, to the treatment with biologic drugs targeting detailed specific receptors, like rituximab, eculizumab or abatacept. Moreover, the data coming from a molecular science revealed that several drugs, which have been previously used exclusively to modify the upregulated adaptive immune system, may also exert a local effect on the kidney microstructure and ameliorate the functional instability of podocytes, reducing the leak of protein into the urinary space. The innate immune system also became a target of new therapies, as its specific role in different kidney diseases has been de novo defined. Current therapy of several immune kidney diseases may now be personalized, based on the detailed diagnostic procedures, including molecular tests. However, in most cases there is still a space for standard therapies based on variable protocols including usage of steroids with the steroid-sparing agents. They are used as a first-line treatment, while modern biologic agents are selected as further steps in cases of lack of the efficacy or toxicity of the basic therapies. In several clinical settings, the biologic drugs are effective as the add-on therapy.
    Type of Medium: Online Resource
    ISSN: 2227-9067
    URL: Article
    DOI: 10.3390/children9040536
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2732685-8
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  • 6
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    Renovascular hypertension masquerading as nephrotic proteinuria in an 10-month-old girl — analysis of errors in diagnostic approach
    VM Media Group sp. z o.o ; 2018
    In:  Arterial Hypertension Vol. 22, No. 3 ( 2018-09-28), p. 143-149
    Details
    In: Arterial Hypertension, VM Media Group sp. z o.o, Vol. 22, No. 3 ( 2018-09-28), p. 143-149
    Type of Medium: Online Resource
    ISSN: 2449-6162 , 2449-6170
    URL: Article
    DOI: 10.5603/AH.a2018.0010
    Language: Unknown
    Publisher: VM Media Group sp. z o.o
    Publication Date: 2018
    detail.hit.zdb_id: 3069004-3
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  • 7
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    Data_Sheet_1.PDF
    Frontiers Media SA ; 2022
    In:  Frontiers in Cardiovascular Medicine Vol. 9 ( 2022-10-31)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 9 ( 2022-10-31)
    Abstract: Left ventricular hypertrophy (LVH) is the main marker of HMOD in children and young people (CYP). We aimed to assess the prevalence of LVH and its determinants in CYP with primary hypertension (PH). Methods A meta-analysis of prevalence was performed. A literature search of articles reporting LVH in CYP with PH was conducted in Medline, Embase, and Cochrane databases. Studies with a primary focus on CYP (up to 21 years) with PH were included. Meta-regression was used to analyze factors explaining observed heterogeneity. Results The search yielded a total of 2,200 articles, 153 of those underwent full-text review, and 47 reports were included. The reports evaluated 51 study cohorts including 5,622 individuals, 73% male subjects, and a mean age of 13.6 years. LVH was defined as left ventricle mass index (LVMI) ≥ 95th percentile in 22 (47%), fixed cut-off ≥38.6 g/m 2.7 in eight (17%), sex-specific fixed cut-off values in six (13%), and miscellaneously in others. The overall prevalence of LVH was 30.5% (95% CI 27.2–33.9), while heterogeneity was high ( I 2 = 84%). Subgroup analysis including 1,393 individuals (76% male subjects, mean age 14.7 years) from pediatric hypertension specialty clinics and LVH defined as LVMI ≥95th percentile only (19 study cohorts from 18 studies), reported prevalence of LVH at 29.9% (95% CI 23.9 to 36.3), and high heterogeneity ( I 2 = 84%). Two studies involving patients identified through community screening ( n = 1,234) reported lower LVH prevalence (21.5%). In the meta-regression, only body mass index (BMI) z-score was significantly associated with LVH prevalence (estimate 0.23, 95% CI 0.08–0.39, p = 0.004) and accounted for 41% of observed heterogeneity, but not age, male percentage, BMI, or waist circumference z-score. The predominant LVH phenotype was eccentric LVH in patients from specialty clinics (prevalence of 22% in seven studies with 779 participants) and one community screening study reported the predominance of concentric LVH (12%). Conclusion Left ventricular hypertrophy is evident in at least one-fifth of children and young adults with PH and in nearly a third of those referred to specialty clinics with a predominant eccentric LVH pattern in the latter. Increased BMI is the most significant risk association for LVH in hypertensive youth.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2022.993513
    DOI: 10.3389/fcvm.2022.993513.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2781496-8
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  • 8
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    High prevalence of extrarenal artery involvement in children with fibromuscular dysplasia – a single-center experience
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Hypertension Vol. 39, No. 12 ( 2021-12), p. 2439-2445
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 12 ( 2021-12), p. 2439-2445
    Abstract: Although the clinical presentation of fibromuscular dysplasia (FMD) and its generalized character has been previously described in adults, data on FMD in children are limited. Method: In this study, we aimed to assess visceral artery involvement in pediatric FMD patients with documented renal artery stenosis (RAS) and renovascular hypertension (RVH) in comparison with healthy individuals. We retrospectively analyzed the results of angiographic studies of 16 patients with a median age of 13.9 years (10 girls) in comparison with 16 age- and sex-matched healthy controls. Results: Out of the 16 FMD patients, 10 (63%) had stenotic lesions identifiable only in renal arteries, whereas six (37%) had additional stenoses in other vascular beds – in the celiac trunk (four patients), superior mesenteric artery (four patients), inferior mesenteric artery (one patient), splenic artery (one patient), common hepatic artery (three patients), and abdominal aorta (one patient). The comparison of ostial diameters of vessels, in which no periostial narrowing, stents, or occlusions were found, revealed that patients with FMD had a significantly smaller diameter of the celiac trunk ( P  = 0.017), splenic arteries ( P  = 0.007), and common hepatic artery ( P  = 0.026) than their age- and sex-matched healthy peers. Conclusion: We found that 69% of children with RVH caused by FMD had clinically silent stenoses or tortuosity of visceral arteries. The results of our study suggest that pediatric FMD is a generalized arterial condition, and the patients may need screening for both renal as well as nonrenal manifestations of the disease.
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/HJH.0000000000002957
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2017684-3
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  • 9
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    THE PREVALENCE AND IMPACT OF ISOLATED DIASTOLIC HYPERTENSION IN CHILDREN
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Hypertension Vol. 40, No. Suppl 1 ( 2022-06), p. e21-e22
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. Suppl 1 ( 2022-06), p. e21-e22
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/01.hjh.0000835476.58691.c8
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2017684-3
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  • 10
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    Atherosclerotic Risk Factors in Children with Celiac Disease
    Hindawi Limited ; 2020
    In:  Gastroenterology Research and Practice Vol. 2020 ( 2020-03-27), p. 1-9
    Details
    In: Gastroenterology Research and Practice, Hindawi Limited, Vol. 2020 ( 2020-03-27), p. 1-9
    Abstract: Introduction and Objectives . Celiac disease (CD) is a complex autoimmune disorder occurring in genetically susceptible individuals. There is limited data on the impact of gluten-free diet (GFD) on the risk of developing cardiovascular diseases. Hereby, we present our study regarding the impact of treatment with GFD on the biochemical risk factors of atherosclerosis. Material and Methods . 277 patients with CD from 7 Polish clinics were enrolled in the study (210 children treated for at least 5 years and 67 children included in the study on the day of CD diagnosis and observed for 1 year on a GFD). We obtained selected clinical data, and we assessed lipid profile, apolipoproteins (A1, B, and E), lipoprotein (a), homocysteine, as well as antioxidants (folic and uric acid), and high-sensitivity CRP (hsCRP) for all patients. The compliance to GFD was verified using anti-transglutaminase antibodies and deamidated gliadin peptide antibodies. As a reference group, the data of 95 healthy children recruited for another project was used, for which we had the results of selected parameters. Results . We found significantly lower concentrations of total cholesterol, lipoprotein LDL-C, apolipoproteins A1 and B, as well as hCRP in all children with CD. We showed decreased level ( 〈 5 ng/mL) of folic acid among 46% of children treated for 〉 5 years. Moreover, we showed significant decrease of folic acid level already after 1 year of a GFD (12 vs . 5.6 ng/mL; p 〈 0.001 ). We also found significant negative correlation of z -score body mass index (BMI) with HDL and APOA1 level ( r = − 0.33 ; p = 0.015 and r = − 0.28 ; p = 0.038 , respectively) and modest positive correlation of z -score BMI with atherogenic factor of total cholesterol-HDL ratio and LDL-HDL ratio ( r = 0.40 ; p = 0.002 and r = 0.36 ; p = 0.006 , respectively). Analysis of physical activity showed an increase in the insulin levels with inactivity ( r = 0.36 ; p = 0.0025 ). We also found positive correlation of the sleep duration with the adiponectin level ( r = 0.41 ; p = 0.011 ). Conclusions . In children with CD treated with a GFD, decreased level of folic acid together with increased BMI, sedentary behavior, and an improper lipid profile may predispose them to atherosclerosis in the long run. This data suggests the need of further studies to determine the need for metabolic cardiovascular risk screening in children with CD.
    Type of Medium: Online Resource
    ISSN: 1687-6121 , 1687-630X
    URL: Article
    DOI: 10.1155/2020/6138243
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2435460-0
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