Left ventricular hypertrophy in pediatric hypertension

Abstract

Introduction. Left ventricular hypertrophy (LVH) is the most commonly assessed target organ effect of hypertension (HTN) among children and adolescents. Left ventricular hypertrophy is an independent predictor of cardiovascular morbidity and mortality in children. Prevention or regression of left ventricle (LV) geometric changes with blood pressure control is an effective way of decreasing future adverse cardiovascular disease outcomes in patients with HTN.Aim of the study. The purpose is to provide background on the importance of LVH in children with HTN, to assess frequency of LVH and determine the correlation between cardiac index of left ventricular mass (LVM) and body mass index (BMI), simpatoadrenale system activity and blood pressure variability.Materials and methods. This study included 20 patients aged 10-18 years with HTN, who were treated in 2018-2019 in the Department of Cardiology of the Institution of Mother and Child. Left ventricular mass was calculated using the formula by Devereux et al. according to the American Society of Echocardiography guidelines. The left ventricular mass index (LVMI) was derived by dividing LVM in grams by the subject’s height in meters raised to the 2.7 power. Left ventricular geometry was classified as normal, concentric remodeling, concentric LVH, or eccentric LVH. Respondents were examined through echocardiography, also the tension values, and BMI were evaluated. Results. Left ventricular hypertrophy was reported in 7 (35%) children with HTN, and in 2 (10%) children severe LVH was determined (> 51 g/m2, 7). Nearly 4 (20%) children with normal arterial blood pressure had LVH. Left ventricular hypertrophy was more frequently detected in boys (n=5; 38%) compared to girls (n=2; 28, 6%). Distribution by LV geometry revealed concentric remodeling of the LV in 1 (5%) patients; concentric hypertrophy was found in 4 ( 20%) hypertensive children and eccentric hypertrophy was detected in 2 ( 10%) patients (p <0,05). The main factors that contribute to development of LVH are: obesity, mean values of systolic blood pressure (131, 4±1, 11 versus 123, 17±1, 22), the level of plasma and urinary catecholamines (85% versus 55%). There is a statistically significant correlation between BMI and LVH (p< 0,001). Thus, in this study, children with LVH were more frequently obese (40%) compared with patients who had normal LVMI (5%). The mean value of BMI percentile in children with LVH was 82, 3 ± 4, 0 kg/m2 compared with 66, 7 ± 3, 5 kg/m2 in subjects with normal LVMI (p<0, 01). Conclusions. The study reveals that LVH is the most common target organ effect of HTN in children. Adaptation of the LV myocardium to pressure overload in hypertensive children resulted in the development of more frequent concentric hypertrophy and eccentric hypertrophy. Obesity and high level of plasma and urinary catecholamines is associated with increased risk for LVM in children.