2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Tuberous sclerosis complex-associated kidney disease in children

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder which can have manifestations in the kidneys, along with other organ systems. Children with TSC may develop kidney lesions at any point during childhood, and typically these are angiomyolipomata (AML) and/or kidney cysts. Children may also have hypertension associated with TSC-associated kidney disease, and rarely reduced kidney function. New guidelines for the management of TSC-associated kidney disease in children and adults were published in 2024. This educational review summarises the relevant clinical aspects of these guidelines for paediatric nephrologists through a series of four clinical cases. These cases cover management of hypertension, frequency of follow-up and frequency of kidney imaging. Difficult clinical scenarios are reviewed, such as the management of TSC2-PKD1 contiguous gene syndrome and the management of large AMLs in children with TSC.

Assessing masked hypertension and ambulatory arterial stiffness index in children congenital kidney malformations

BACKGROUND

Patients diagnosed with congenital kidney malformations are at an increased risk of developing hypertension, proteinuria, and progressing to chronic kidney disease (CKD). The present study aimed to determine the frequency of masked hypertension and ambulatory arterial stiffness index (AASI) in patients with congenital kidney malformations.

METHODS

The study included 174 patients with congenital kidney malformations (48 patients with unilateral renal agenesis (URA), 40 patients with ectopic kidney (EK), 36 patients with horseshoe kidney (HK), 31 patients with multicystic dysplastic kidney (MCDK), 19 patients with unilateral renal hypoplasia (URH), and 45 healthy controls.

RESULTS

The mean age was 12.9 ± 2.9 years, and the male-to-female ratio was 1.5. No significant differences were observed between the congenital kidney malformations groups concerning age, sex, follow-up period, proteinuria, or estimated glomerular filtration rate (eGFR) (P > 0.05). Nevertheless, the prevalence of masked hypertension exhibited a statistically significant increase in the congenital kidney malformations groups (except the URH group) compared to the control group (P < 0.05). The AASI was significantly greater in the congenital kidney malformations groups than in the control group (P < 0.05). The nighttime diastolic blood pressure (DBP), mean arterial pressure (MAP), and DBP index were significantly different between the congenital kidney malformations groups (P < 0.05). However, there were no significant differences in nondipping pattern, proteinuria, or masked hypertension between the congenital kidney malformations groups.

CONCLUSIONS

Patients with congenital kidney malformations should be periodically evaluated throughout life for BP. Based on the present findings, we strongly recommend ABPM for the diagnosis of masked hypertension and outcomes, including AASI score.

Attitude, knowledge, and practice of medical students and pediatric physicians towards blood pressure measurement and hypertension in children: The impact of educational sessions

Accurate blood pressure measurement in pediatric patients is crucial for the proper diagnosis and management of hypertension in children. Understanding the level of attitude, knowledge, and practices (AKP) of medical students and physicians on pediatric blood pressure (BP) measurement and hypertension is essential. This is to assess their awareness of this subject which is often overlooked and where research is lacking. This study aims to evaluate the extent of AKP, among medical students and pediatric doctors regarding hypertension and BP measurement in children, and to determine the impact of educational sessions on their AKP. In a cross-sectional study, a self-designed questionnaire composed of several questions about AKP was prepared and validated. After obtaining informed consent, the questionnaire was distributed online to medical students and pediatric physicians with 168 responses, 140 medical students, and 28 pediatric physicians. This was followed by an educational awareness session about measuring blood pressure and hypertension in children. After the session, a post-awareness questionnaire was administered, gathering 145 responses. The average scores for AKP were calculated, and pre- and post-awareness session responses were compared within each group, P < .05 was regarded as significant. Among the medical students, 53.6% were somewhat aware of pediatric hypertension; 29.3% measured BP during their pediatric course, and 85% did not participate in pediatric hypertension education. Among physicians, 12.5% were exposed to pediatric patients with hypertension in the past year, 25% never measured BP in routine pediatric visits, and only 25% used normative BP tables. Average scores (out of 5) for attitude, knowledge, and practices were 3.57 (0.55), 2.51 (0.71), and 2.42 (0.68), respectively, with significantly higher scores in post-educational session, 4.56 (0.47), 4.06 (0.72), and 4.25 (0.76), respectively. The AKP among medical students and pediatric physicians regarding pediatric hypertension are inadequate, ranging from little to moderate. The impact of educational sessions is significant and very useful and should be incorporated into the teaching of medical students especially in the last years of study and ground meetings of pediatric physicians.

Within-visit blood pressure variability in children and adolescents in the National Health and Nutrition Examination Survey (2013-2020)

BACKGROUND

Blood pressure (BP) varies depending on several factors. The objective of our study was to describe within-visit BP variability (BPV) in healthy children and compare BPV between manual and automated BP readings.

METHODS

We included individuals aged 8-17 years with three BP readings from NHANES 2013-2020 cycles. From 2013 to 2016, BP was obtained using auscultation (manual protocol, MP) and, subsequently, using oscillometry (automated protocol, AP). We excluded individuals with DBP 'zero'.

RESULTS

In 5656 individuals [MP group: 3365 (59.5%); AP group: 2291 (40.5%]), a ΔBP (difference between highest and lowest of three BP readings) at least 5 mmHg was noted in 49.1 and 60.7% of individuals for SBP and DBP, respectively. ΔDBP at least 10 mmHg was twice as common in the MP group as in the AP group. ΔDBP at least 20 mmHg was observed in 4.4% individuals. A difference of at least 5 mmHg between the initial and averaged second and third BP readings was noted in 24.9 and 34.5% of individuals for SBP and DBP, respectively. The highest of three BP readings was the first, second, or third in 44.2, 30.5, and 25.4% of individuals, for SBP, and 42.4, 29.8, and 27.7%, for DBP respectively.

CONCLUSION

Less than half of individuals had three DBP readings within 5 mmHg and some had ΔBP at least 20 mmHg. Initial BP is not always the highest; inclusion of the second and third BP readings may be more representative of the individual's actual BP. DBPV was higher with manual than with automated BP measurement.

Hypertension Management Dynamics in Pediatric CKD: Insights From the 4C Study

BACKGROUND

Office blood pressure (BP) trajectories may help assess hypertension progression and the effects of antihypertensive treatment in children with chronic kidney disease.

METHODS

Analysis of antihypertensive treatment and BP slopes in 320 patients from the 4C study (Cardiovascular Comorbidity in Children with Chronic Kidney Disease) cohort with chronic kidney disease before renal replacement therapy, based on a minimum of 3 individual observations and 2 years of follow-up.

RESULTS

At enrollment, 70 (22%) patients had uncontrolled or untreated hypertension, 130 (41%) patients had controlled hypertension, and 120 (37%) patients had normotension without antihypertensive treatment. Antihypertensive treatment medication was prescribed for 53% of patients at baseline and initiated or added for 91 patients (AHT-I group, 28%) during follow-up. Overall BP SD score remained stable over time in the cohort (β=-0.037±0.034, P=0.34 and -0.029±0.348, P=0.093 per year for systolic and diastolic BP SD score). In the AHT-I group, systolic and diastolic BP SD scores were higher at baseline and decreased significantly during follow-up (-0.22±0.07, P<0.003 and -0.12±0.05 SD score per year, P=0.01). Only 8 of 70 (11%) patients from the previously untreated/uncontrolled group remained untreated at the last observation, while 31 (44%) were controlled during follow-up. Of the 120 normotensive patients at baseline, 60% remained normotensive while 40% progressed to uncontrolled/untreated (n=23, 19%) or controlled (n=24, 20%) hypertension.

CONCLUSIONS

Although the overall BP of the population remained stable over time, individual patterns of BP management showed considerable variability. BP control improved significantly with intensified antihypertensive therapy; however, a significant number of previously normotensive individuals developed new-onset hypertension during the observation period.

Childhood obesity: The threatening apprentice of the adiposity empire

Childhood obesity is a global health problem, with its prevalence having tripled since 1975. The increase in its prevalence has been predominantly in developing countries, but also in those with high economic status. Nowadays, there are multiple obesity definitions, however, one of the most accurate is the one which defines obesity as the accumulation of excessive body adiposity and not as an body weight excess. Nevertheless, the body mass index (BMI) is the most frequently used tool for its classification, according to the cut-off points established by the Center for Disease Control and World Health Organization tables. In children and adolescents an adiposity excess is related to the appearance of cardiovascular disease in adulthood and with many comorbidities such as metabolic syndrome, insulin resistance, type 2 diabetes, hypertension and metabolic dysfunction-associated steatotic liver disease, among others. Currently, there is still controversy about which is the ideal indicator for measuring overweight and obesity. BMI is still used as a standardized measure but may miss cases in which body composition is pathological despite a BMI within the normal-weight category. An adequate knowledge of the impact on health of dysfunctional adiposity as well as its accurate diagnosis will allow health professionals to address this condition in a more precise and comprehensive manner, and substantially improve the associated cardiometabolic risk and prognosis.

Lifelong impact of elevated blood pressure from childhood to adulthood

Elevated blood pressure (BP) during childhood and adolescence is increasingly being recognized as a precursor to adult hypertension and cardiovascular disease (CVD). This review examines the existing evidence of the relationship between early BP elevations and long-term cardiovascular (CV) outcomes. Previous studies demonstrated a moderate association between childhood BP and adult hypertension, with early BP elevations contributing to subclinical CV changes such as left ventricular hypertrophy and increased carotid intima-media thickness as well as major premature CVD events in adulthood. However, evidence also indicates that BP normalization before adulthood may mitigate these risks, suggesting a critical interventional window before irreversible CV changes occur. Multiple modifiable and nonmodifiable factors contribute to early-life BP elevations, including genetic predisposition, a high sodium intake, obesity, sedentary behavior, and sleep disturbances. Although establishing a direct causal association between childhood BP and adult hypertension or CVD remains challenging owing to the need for longterm follow-up and large sample sizes, further research is essential to addressing the existing knowledge gaps in pediatric hypertension prevention, detection, impact, and treatment. This review highlights the importance of preventing BP elevations early in life to reduce the longterm burden of hypertension and CVD. Promoting healthy behaviors, such as maintaining a healthy weight, reducing one's sodium intake, engaging in physical activity, and ensuring adequate sleep, is essential for managing BP at an early age. These efforts reduce individual CV risk and help alleviate the broader future public health burden of hypertension and CVD.

Investigations for diagnosis of secondary hypertension in children: yield and costs

BACKGROUND

Screening for secondary hypertension is not recommended for all hypertensive patients, but missing these cases is critical. We aimed to (i) assess hypertension causes in a cohort of hypertensive children, (ii) determine the costs and contributions of an extended diagnostic work-up to screen for secondary hypertension, and (iii) compare the performance of a "short diagnostic work-up" with the protocols of the American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH).

METHODS

We conducted a retrospective, single-center study of 70 hypertensive patients aged 1-18 years. All underwent an extended work-up to exclude secondary hypertension. Diagnostic findings, test counts, and costs were analyzed. A short work-up (serum creatinine, fasting glucose, electrolytes, urinalysis, kidney ultrasound (US), and renal artery Doppler US), as well as the AAP and ESH protocols, was evaluated for performance and costs.

RESULTS

Secondary hypertension was identified in 29 patients (41.4%). The extended protocol identified or excluded secondary causes in all patients. Kidney US had the highest diagnostic yield (37.1%). The short work-up and ESH protocol identified all secondary cases, whereas the AAP protocol missed 15 diagnoses. The extended protocol cost € 17,715.60 (€ 253.08 per patient). Direct cost savings were 64.3% with the short work-up, 92.4% with the AAP protocol, and 76.2% with the ESH protocol.

CONCLUSIONS

Primary is more common than secondary hypertension in children, with kidney parenchymal disease being the leading secondary cause. As recommended by guidelines, a simplified, focused work-up may offer a cost-effective alternative to extensive screening while maintaining diagnostic accuracy.

Current status of elevated blood pressure and hypertension among adolescents in Asia: a systematic review

Background

Hypertension among adolescents in Asia is an emerging public health concern that is directly associated with early onset cardiovascular risks. As such, it can also lead to further health issues and challenges for health care in the future. As existing studies have predominantly focussed on adult populations, we sought to provide targeted insights into adolescent hypertension across Asia, elucidating the impact of rapid lifestyle and environmental changes on this younger population. Therefore, in this systematic review, we aimed to evaluate the prevalence and trends of elevated blood pressure (BP) and hypertension among adolescents aged 10-19 years across Asia, address gaps in region-specific data, and determine any demographic risk factors.

Methods

Following PRISMA guidelines, we searched PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus for cross-sectional studies on adolescent hypertension/elevated BP in Asia published from January 2019 to June 2024, after which we narratively synthesised their findings.

Results

Of the 2634 retrieved studies, 39 met the inclusion criteria, covering over 200 000 adolescents in Asia. The prevalence of hypertension ranges from 0.7% in urban Bangladesh to 24.5% in urban Malaysia, with urban areas generally showing higher rates than rural areas (e.g. India: 8.4% urban vs. 5.7% rural). By region, East Asia has the highest overall prevalence (14.25%), followed by West Asia (14.14%), South Asia (13.77%), Southeast Asia (13.16%), and Central Asia (12.37%). Males had higher prevalence rates (for example, 22.3% in Chinese males vs. 20% in females).

Conclusions

The increasing prevalence of adolescent hypertension in urban Asia is a significant public health concern. Although extensive research has been conducted in East and South Asia, there is a dearth of studies in Western, Southeast, and Central Asia, emphasising a need for future research. Standardised diagnostic criteria and targeted interventions are crucial for addressing regional disparities and reducing long-term cardiovascular risks.

Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1-Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance

BACKGROUND

The ketogenic diet has been successfully used in the last 100 years in the treatment of epilepsy and other neurological disorders. In recent decades, it gained wider application in the treatment of obesity, metabolic syndrome, and type 2 diabetes. However, there have been only a few studies on its use in children with obesity and associated metabolic disorders.

OBJECTIVES

To determine the clinical and metabolic effects of a well-formulated low-carbohydrate (ketogenic) diet in children with obesity.

METHODS

One hundred children with obesity and metabolic disorders underwent initial anthropometric, laboratory, and ultrasound examinations. They were placed on a well-formulated ketogenic diet and monitored for 4 months. The 58 patients who completed the study underwent follow-up examinations to assess the effects of the diet on anthropometric, clinical, and laboratory markers of metabolic syndrome and insulin resistance, cardiovascular risk factors, and certain hormone levels. Compliance with the diet, common difficulties in adhering to it, side effects, and positive changes in the patients' health were analyzed.

RESULTS

At the end of the study, the average weight loss for the entire group was 6.45 kg, with a reduction in BMI of 3.12 kg/m2. Significant improvements were also observed in insulin resistance indicators, including fasting insulin levels, HOMA-IR index, QUICKI (p < 0.0001), and adiponectin (p = 0.04). The cases of hepatosteatosis decreased twofold, the number of patients with arterial hypertension was significantly reduced, as well as the number of children receiving antihypertensive therapy. Additionally, the number of patients meeting the criteria for metabolic syndrome decreased threefold.

CONCLUSIONS

A well-formulated short-term ketogenic diet is effective in treating obesity, metabolic syndrome, and related comorbidities, and can be part of a comprehensive approach for these patients.

Blood pressure measurement practices in children and adolescents within primary care setting

Objective

Poor compliance to the technical aspects of blood pressure (BP) measurement procedure may lead to inaccurate estimation of BP and misclassification of patients. However, the latter have not been explored systematically. We aimed to assess real-life BP measurement practices in Lithuanian children and adolescents at the primary care setting, and their compliance with current European Society of Hypertension (ESH) guidelines.

Methods

Two cross-sectional surveys were conducted in Lithuania. The study population included parents, who have children aged 0-17 years, and was further enriched by adolescents aged 14-17 years. Original questionnaires were developed and used to survey the participants.

Results

Study included 1,504 parents and 448 adolescents. Median age of the surveyed parents' children and adolescents was 6 years and 50.2 percent were female. Overall, among all children aged 3 years or older only 55% of respondents reported BP measurements at least once. The rates of BP measurements increased with age and exceeded 80 percent from 14 years. Only 3.3 percent of respondents reported no issues with BP measurement procedure. The most common errors included single measurements of BP (81.4%), lack of feedback (60.2%), incorrect positioning (40.7%), miscuffing (39.2%) and lack of rest period (27.9%).

Conclusions

Our study reveals not only insufficient BP screening rates within Lithuanian primary care setting, but also high rates of technical errors during BP measurement procedure. Collectively, these issues likely contribute to misdiagnosing of arterial hypertension and suboptimal care of children who are at risk of inaccurate and imprecise BP results.

Predictors of hyperkalemia in pediatric patients on dialysis: international prospective observational study

BACKGROUND

Hyperkalemia is an important issue in kidney failure. The aim of the study was to investigate the predictors of hyperkalemia in children receiving maintenance dialysis.

METHODS

This was an international prospective cross-sectional observational study involving patients < 18 years receiving chronic hemodialysis or peritoneal dialysis. Hyperkalemia was defined as serum potassium (sK+) ≥ 5 mEq/L based on the Pediatric Renal Nutrition Taskforce recommendations. We recorded age, dialysis vintage, urine output (24-h urine collection); dietary K+, energy, protein and sodium intake (three-day diaries); office blood pressure (BP) in children < 5 years and 24-h ABPM in older patients; biochemistry (creatinine, urea, sodium, bicarbonate, hemoglobin, phosphate, albumin) and antihypertensive drugs.

RESULTS

Forty-one patients were enrolled (10 peritoneal dialysis, 31 hemodialysis), median age 13.3 (IQR 10.6-15.8) years; 15 of them (36.6%) showed hyperkalemia, and median sK+ was 4.7 (4.4-5.0) mEq/L. Renin-angiotensin-aldosterone system inhibitors (RAASi) were prescribed in 9/15 patients with hyperkalemia (60%) and 7/26 (26.9%) without hyperkalemia (p = 0.04). Patients with hyperkalemia were older and had higher urea and creatinine than those with normal sK+. A backward stepwise multivariable model showed that the only predictors of hyperkalemia were age (b = 0.53, p = 0.01), urea (b = 0.02, p = 0.03) and treatment with RAASi (b = 2.75, p = 0.021).

CONCLUSIONS

While higher age, higher urea levels and treatment with RAASi independently predicted the occurrence of hyperkalemia, K+ intake was not associated with sK+ in children on dialysis. This emphasizes the importance of considering non-dietary causes of hyperkalemia and considering the bioavailability of K+ more than the total dietary K+ intake.

Prevalence of Hypertension in Adolescents: Differences Between 2016 ESH and 2017 AAP Guidelines

Introduction: The American Academy of Pediatrics (AAP) published in 2017 new guidelines for the screening and management of hypertension in children containing different nomograms compared to the European guidelines, leading to a reclassification of blood pressure values, the consequences of which are still little investigated. The aim of our study was to evaluate the prevalence of high blood pressure values estimated with both the most recent American and European guidelines and to analyze the relationship of blood pressure increases with lifestyles and potentially risky behaviors in a school population in Western Sicily. Methods: On the occasion of the XV World Hypertension Day, blood pressure values of 1301 students aged between 13 and 18 were measured. Two questionnaires were administered, one relating to anamnestic data and anthropometric parameters and a second aimed at investigating lifestyle. For the diagnosis of increased blood pressure, both ESH and AAP criteria were considered. Results: The prevalence of elevated blood pressure was 7.5% according to ESH criteria and nearly twice as high using AAP criteria, with a more pronounced discrepancy in females. Individuals with elevated blood pressure were younger, exhibited higher body weight and BMI, and had an increased prevalence of overweight and obesity. Classification based on ESH criteria revealed higher alcohol and drug consumption among normotensive individuals. AAP criteria identified a higher proportion of males and greater height in the hypertensive group. Systolic blood pressure correlated significantly with height, weight, and BMI, with stronger associations in males, while diastolic pressure correlated with weight and BMI. Conclusions: To the best of our knowledge, our study is the only one to analyze the prevalence of increased blood pressure and its relationship with lifestyle factors and anthropometric data in adolescence in our region. Our study confirms that elevated blood pressure is common in adolescence, with higher prevalence using the 2017 AAP criteria than ESH guidelines.

Prevalence of and Factors Associated with Hypertension in Children and Adolescents as Observed by German Pediatricians-A Case-Control Study

Background: Blood pressure elevation in children is an important health concern. The extent to which hypertension is diagnosed in German pediatric practices is not yet known. The aim of this study is, therefore, to examine the prevalence of hypertension diagnosis in children and adolescents treated in pediatric practices, as well as the factors associated with hypertension in this population. Methods: This retrospective case-control study used electronic medical records from 258 primary care pediatricians in Germany and included children and adolescents aged 0-17 years with an initial documented diagnosis of primary hypertension between January 2005 and December 2023. Hypertension patients were matched 1:5 with non-hypertension patients by age and sex. Conditional multivariable logistic regression models were used to estimate the association of chronic diseases and therapies with a risk of hypertension. Results: After 1:5 matching, the present study included 7482 children and adolescents with hypertension, and 37,410 controls without hypertension. The average prevalence of hypertension was 0.12% and the incidence was 1.24 cases per 1000 person-years, both increasing with age. In the multivariable regression analysis, a significant positive association was observed between hypertension and ten disorders including obesity (odds ratio, OR: 6.91; 95% confidence intervals, CI: 6.28-7.60), type 1 diabetes mellitus (OR: 2.85; 95% CI: 2.13-3.82), dyslipidemia (OR: 1.99; 95% CI: 1.46-2.72), chronic bronchitis (OR: 1.63; 95% CI: 1.39-1.90), hypothyroidism (OR: 1.62; 95% CI: 1.30-2.02), migraine (OR: 1.52; 95% CI: 1.17-1.98), ADHD (OR: 1.45; 95% CI: 1.28-1.65), scoliosis (OR: 1.40; 95% CI: 1.13-1.73), chronic rhinitis (OR: 1.31; 95% CI: 1.14-1.50), and reaction to severe stress and adjustment disorders (OR: 1.31; 95% CI: 1.04-1.65). Furthermore, paracetamol prescription was positively associated with hypertension risk (OR: 1.68; 95% CI: 1.41-2.00). Conclusions: The significant associations between hypertension and chronic disorders, particularly obesity, underscore the need for early prevention strategies. Prospective studies are needed to confirm these associations. Similarly, pathophysiological and mechanistic explanations for the associations identified need to be explored and verified in properly designed studies.

Infant Gut Microbiota and Childhood Blood Pressure: Prospective Associations and the Modifying Role of Breastfeeding

BACKGROUND

Germ-free mice experiments indicate that human gut microbiota influence blood pressure (BP), but no studies have prospectively examined if infant gut microbiota affects their future childhood BP. We aim to investigate prospective associations of infant gut microbiota diversity and composition with childhood BP, examining effect measure modification by breastfeeding and mediation by a child's body mass index.

METHODS AND RESULTS

In the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort, we measured infant gut microbiota (16S rRNA V4) at 1 week, 1 month, and 1 year and child BP at 3 and 6 years. We assessed α diversity-BP, β diversity-BP, and microbe abundances-BP associations using linear regression, permutational multivariate analysis of variance, and beta-binomial count regression, respectively. Data from 526 children showed that α diversity and several Bifidobacterium spp. had protective associations with BP but only in children breastfed for ≥6 months. For instance, a 1-unit increment in 1 month Shannon index was associated with 1.86 mm Hg (95% CI, 0.66-3.05) lower 6-year systolic BP in children breastfed ≥6 months but a 0.73 (95% CI, -1.00 to 2.45) higher 6-year systolic BP in those breastfed <6 months (P-interaction=0.02). Greater abundance of 2 Bifidobacterium microbes at 1 week was negatively associated with 6-year systolic BP when breastfeeding ≥6 months (P-interaction<0.1). Further, abundance of 8 microbes at 1week or 1 month was linked to 3-year or 6-year BP (false discovery rate P<0.05), with 5 of them independent of a child's body mass index. Lastly, 1-week unweighted UniFrac distance and 1-year weighted UniFrac distance were associated with BP after adjustment (P<0.05).

CONCLUSIONS

Gut microbiota features at 1 week and 1 month of life were associated with BP at 6 years. Breastfeeding duration modified key associations including those for α diversity and Bifidobacteria.

Evaluation of salusin-β in paediatric patients with chronic kidney disease or hypertension

PURPOSE

Salusins are newly identified endogenous peptides implicated in the atherosclerotic process. Salusin-β, in particular, is recognized for its proatherogenic role. Given that atherosclerosis can commence in childhood, salusin-β holds promise as a potential biomarker for cardiovascular risk assessment. The objective of our study was to investigate salusin-β levels in children with early stages of chronic kidney disease (CKD) or hypertension (HTN), and compare them to healthy controls. Furthermore, we aimed to evaluate its association with obesity and pulse wave velocity (PWV), the latter being a well-established marker for determining arterial elasticity.

MATERIALS AND METHODS

This cross-sectional study involved 96 paediatric patients, including 46 with CKD and 50 with HTN, as well as 33 healthy controls. Anthropometric measurements, PWV assessments, serum salusin-β values, and basic laboratory investigations were conducted for all participants.

RESULTS

Salusin-β levels were found to be elevated in patients with CKD (p ​= ​0.014), but not in patients with HTN when compared to healthy controls. When correlating salusin-β levels with PWV, a significant but weak correlation was observed (r ​= ​0.211, p ​= ​0.020).

CONCLUSIONS

Salusin-β levels were elevated in paediatric patients with CKD. Additionally, salusin-β levels correlated significantly with PWV. Obesity played a smaller role in these correlations, with significant correlations observed only after combining cardiovascular risk factors revealing certain associations between salusin-β levels and some cardiovascular variables, but with inconclusive findings and, in some instances, even contrary to anticipated outcomes.

The association of obesity and hyperuricemia with ambulatory blood pressure in children

BACKGROUND

Primary hypertension (HTN) in children is on the rise and linked to the childhood obesity epidemic. Recent studies support the role of hyperuricemia in the pathogenesis of HTN. With this study we intend to evaluate the effect of body mass index (BMI) and uric acid levels on daily blood pressure (BP) parameters/phenotypes and target organ damage (TOD).

METHODS

A mean ambulatory systolic and/or diastolic BP ≥ 95th percentile or above the adolescent cut points was defined as 'HTN'. Patients were grouped as group 1 normal weight, and group 2 overweight/obese.

RESULTS

Of the 140 children (89 male/51 female) with a mean age of 13.9 ± 2.6 years, 21 were overweight and 86 were obese. Mean 24-h systolic BP (SBP) and daytime SBP were higher in group 2 (p = 0.015, p = 0.011). BMI was positively correlated with 24-h SBP (r = 0.272, p = 0.001) and daytime SBP (r = 0.280, p = 0.001). Uric acid level showed a moderate correlation with daytime SBP (r = 0.311, p < 0.01). Logistical regression analysis showed that daytime SBP is independently associated with obesity (OR 7.44, 95%CI 2.7-20.6, p < 0.001) and male sex (OR 4.60, 95%CI 2.0-10.2, p < 0.001), but not uric acid. Left ventricular hypertrophy was more common in non-dippers (p = 0.044).

CONCLUSIONS

Male sex and BMI are independently associated risk factors for systolic BP. The association between non-dipping pattern and TOD suggests the widespread use of ambulatory blood pressure monitoring (ABPM) in childhood HT. In this paper, we could not demonstrate an independent association between uric acid and SBP. The effect of uric acid on SBP seems to be regulated by other metabolic factors in addition to uric acid.

Prenatal exposure to essential metals and blood pressure at preschool age: A birth cohort study

AIMS

To investigate the association between prenatal exposure to essential metals and the offspring blood pressure (BP) at preschool age.

MATERIALS AND METHODS

Data from a birth cohort study including 1113 mother-child pairs were analyzed. The associations between individual prenatal essential elements and offspring BP were analyzed using generalized linear regression models. Bayesian Kernel Machine Regression (BKMR) and weighted quantile sum regression (WQS), were employed to examine the combined effects of prenatal metal exposures on offspring BP. The associations between essential metals and high blood pressure (HBP) of offspring were appraised using logistic regression model.

RESULTS

In the single-metal models, we found that maternal magnesium (Mg) concentrations were negatively associated with the offspring BP. The results of BKMR and WQS also identified a negative association between maternal essential metals mixtures and offspring BP. Logistic regression showed that compared to the highest quartiles of maternal Mg, the odds ratio (OR) for HBP in the lowest quartiles was 4.27 (95 % CI: 1.84-9.93). No significant associations were observed for other essential metals (all P value > 0.05). Additionally, no significant association was found between umbilical cord blood metal concentrations and offspring BP.

CONCLUSIONS

Maternal essential metals mixtures, rather than those in umbilical cord blood, were negatively associated with offspring BP. Besides, lower maternal Mg levels were linked to a higher prevalence of HBP in offspring. Our findings provide significant evidence for exploring the effects of maternal essential metal elements on offspring BP.

Real-world evidence of lisinopril in pediatric hypertension and nephroprotective management: a 10-year cohort study

BACKGROUND

Over the last 20 years, pediatric hypertension (pHTN) prevalence in Western society has risen from 3.5 to 9% due to childhood overweight, obesity, and secondary kidney and cardiological conditions. Few studies have assessed commonly used antihypertensive medication lisinopril's (ACE-inhibitor) long-term efficacy and the long-term value of renin-angiotensin-aldosterone system (RAAS) biomarkers.

METHODS

This is a retrospective cohort study at Ghent University Hospital, Belgium, with 106 young patients (1-18 years) treated with lisinopril due to hypertension (HTN) and chronic kidney disease (CKD) assessed for treatment outcomes against clinical benchmarks over 10 years.

RESULTS

Lisinopril was mainly initiated for secondary hypertension or nephroprotection (89%) due to kidney causes. A starting dose across groups was lower than 0.07 mg/kg for 48% (n = 50). HTN patients without CKD achieved systolic blood pressure below the 95th percentile within 2 years, but efficacy declined after 2.5 years. CKD patients maintained a steady response, reaching systolic targets by 40 months and showing improved diastolic control over 70 months. Proteinuria reduction had a median urine protein creatinine ratio (UPCR) to 0.57 g/g at 6 months, with a reappearance of UPCR 2 g/g creatinine after 40 months. Aldosterone breakthrough occurred from 6 months onward in all groups. Over 70 months, aldosterone and aldosterone-renin-ratio (ARR) progression significantly differ between children with and without normal kidney function.

CONCLUSIONS

Treatment efficacy for systolic blood pressure in hypertensive patients with abnormal kidney function diminishes after 2.5 years and for proteinuria in children after 3 years, highlighting the need for dosage recalibration according to guidelines and/or the need for alternative treatments.

Validation of the Uscom BP+ automated oscillometric blood pressure monitor for professional office use in children and adolescents according to the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018)

To (1) assess the accuracy of the Uscom BP+ oscillometric upper-arm professional blood pressure (BP) monitor in children and adolescents as per the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018); (2) assess the suitability of a non-standard cuff; and (3) assess the impact of motion artefact on device accuracy and precision. Children and adolescents were recruited to fulfil the sex/cuff distribution criteria of the Universal Standard. Single arm sequential BP measurements were used, the test device measured on deflate with an altered child/adolescent algorithm, using three standard (Extra Small, Small Adult, Adult) and, as exploratory analysis, additionally in one non-standard cuff (Wide Range; WR) (arm circumferences: 12-17, 16-24, 22-32, 22-42 cm, respectively). The presence of motion artefact was determined and its impact on BP assessed. One-hundred-forty participants were recruited with 123 included for analysis. When using the Extra Small, Small Adult and Adult cuffs only, the BP+ passed both criteria (95 participants, 321 pairs, -0.1 ± 7.3/ - 1.6 ± 7.6 and 5.72/6.50 mmHg systolic/diastolic) (reference thresholds: ≤5 ± 8, ≤6.95/6.76, respectively). The inclusion of the WR cuff showed unacceptable imprecision, and motion artefact had a substantial influence on test device precision. The Uscom BP+ fulfilled the requirements of the Universal Standard in children and adolescents when using the altered algorithm with the three standard cuffs and can be recommended for clinical use. The WR cuff cannot be recommended in this population in measure-on-deflate mode due to its imprecision. Additionally, BP measurement accuracy in children and adolescents can be improved through inclusion of a motion artefact detection system.

Multiple office blood pressure monitoring for the diagnosis of hypertension in children

The measurement (M) of blood pressure (BP) in children may be challenging, and the ideal approach, free of critical issues (such as the interference due to the white coat effect or to the high variability), has yet to be identified. Herein, we compare BP as measured with multiple office BP monitoring (mOBPM) with the standard approach as suggested by guidelines. A cohort of healthy children underwent two mOBPMs 1 year apart. Mean systolic and diastolic values obtained by mOBPM were compared with the 1st, 2nd, 3rd, and 4th measurements (repeated measures ANOVA). mOBPMs with a coefficient of variation (CV) > 15% were excluded. The number of children with BP > 90th centile was determined based on (a) each of the initial three readings, (b) the mean of the 2nd and 3rd Ms, (c) the 4th M, (d) the mOBPM at baseline, and (e) 1 year apart. Out of 164 enrolled children, 13 (7.9%) were excluded because of a CV > 15%. The analysis on the remaining 151 children showed that the first three Ms provided a significantly higher BP than the mOBPM. The 4th M was the first one to be aligned with the results of the mOBPM. Based on the 1st, 2nd, 3rd, and 4th Ms, a BP > 90th centile was observed in 29, 20, 21, and 16 children, respectively. The mean of the 2nd and 3rd Ms identified 12 children with high BP, while the mOBPM revealed elevated BP in only 6 children and this finding was confirmed only in 3 of them 1 year later.

CONCLUSION

The first three readings systematically overestimate BP, while the 4th one better aligns with the mOBPM. If the 4th reading is abnormal, the complete mOBPM will likely offer a more reliable BP assessment.

WHAT IS KNOWN

• Blood pressure measurement may be challanging and initial readings systematically overestimate real values.

WHAT IS NEW

• The 4th blood pressure reading better aligns with the mean of 10 measurements. In daily clinical practice, if the 4th reading is abnormal, the complete mOBPM (www.mobpm.com) will likely offer a more reliable BP assessment.

Determinants of Longitudinal Changes in Exercise Blood Pressure in a Population of Young Athletes: The Role of BMI

AIM

Higher exercise blood pressure in adults correlates with many cardiometabolic markers. The aim of this study was to investigate the main determinants of longitudinal variations in exercise blood pressure in young athletes.

METHODS

A longitudinal retrospective study was conducted on adolescent athletes who underwent at least two sport-related pre-participation screening visits, including exercise testing with a standardized incremental ramp protocol on treadmill. Blood pressure was assessed at rest (SBPrest), at the 3rd minute of exercise (SBP3min), and at peak exercise (SBPpeak). Predictors of blood pressure response (i.e., respective changes vs. baseline (Δ)) were determined by multivariate regression models after adjustment for age, sex, follow-up duration, related baseline SBP values, characteristics of sport, and ΔBMI.

RESULTS

A total of 351 young athletes (mean age at baseline 13 ± 2 years, 54% boys, average follow-up duration 3.4 ± 2.2 years) were enrolled. BMI increased by 1.5 ± 1.8 kg/m2 (p < 0.001) during follow-up. At baseline, mean SBPrest was 103 ± 14 mmHg, mean SBP3min 124 ± 18 mmHg, and mean SBPpeak 154 ± 23 mmHg. A significant between-visit increase in SBPrest (ΔSBPrest 7.0 ± 17.4 mmHg; p < 0.001), ΔSBP3min (4.8 ± 11 mmHg, p < 0.001), and ΔSBPpeak (11.7 ± 24 mmHg, p < 0.001) was observed. ΔSBP3min was significantly predicted by male sex (p < 0.01), baseline BMI (p < 0.01), ΔBMI (p < 0.01), and number of practiced sports (p < 0.05), whereas ΔSBPpeak was positively predicted by male gender (p < 0.01), baseline BMI (p < 0.05), and ΔBMI (p < 0.01) and negatively by baseline resting heart rate (p < 0.01). In a logistic regression model, ΔBMI was the only independent determinant of passing from a lower to an upper quartile of SBP3min (p < 0.001), while ΔBMI and male sex were independent determinants of moving to a higher quartile of SBPpeak (p < 0.001).

CONCLUSIONS

Increase in BMI during development and male sex are independent determinants of the increase in exercise blood pressure, both at light and maximal intensity, in a population of adolescent athletes.

A Multivariate prediction model for amlodipine therapeutic efficacy in pediatric primary hypertension

Background

There are currently no biomarker-based prediction models for amlodipine therapeutic efficacy in pediatric hypertension. This study aimed to identify potential biomarkers and establish a biomarker-based model for predicting amlodipine therapeutic efficacy in pediatric primary hypertension (PH).

Methods

From January 2022 to December 2023, 165 children and adolescents with PH prescribed amlodipine were recruited at our department for a prospective observational study. Patients were grouped into Responders and Non-responders after one month treatment. The baseline data in the two groups were analyzed to identify variables associated with amlodipine treatment responsiveness; furthermore, a nomogram prediction model was established based on those potential predictors derived from multivariate regression analysis. This model's discrimination and calibration were evaluated by a series of statistical methods and internal validation was done using the bootstrap sampling method (1000 resamples).

Results

Eighty-nine patients responded to amlodipine while 76 did not. After statistical adjustment, 4 variables were found to be independently associated with therapeutic efficacy, including hyperinsulinemia (OR = 3.000, 95% CI: 1.409-6.386, p  = 0.004), insulin resistance (OR = 2.354, 95% CI: 1.032-5.370, p = 0.042), the baseline plasma Endothelin-1 level (OR = 0.627, 95% CI: 0.532-0.740, p < 0.001) and amlodipine dosages (OR = 1.743, 95% CI: 1.400-2.169, p <0.001). Compared to the baseline model, the full model with the four variables had a good calibration with an area under the curve (AUC) of 0.967 (95% CI: 0.945-0.990), yielding a sensitivity and a specificity of 91.0% and 92.1%, respectively; the clinical decision curve showed a positive net benefit. Additionally, a nomogram model was established based on the four variables and evaluated by bootstrap internal validation with the c-statistic of 0.865 and the calibration curve being close to the ideal line (p > 0.05).

Conclusion

A nomogram model with high predictive value for amlodipine therapeutic efficacy in pediatric PH was established. This model may be potentially applied to guide the selection of amlodipine for the treatment of pediatric PH.

Effectiveness of relaxation techniques for stress management and quality of life improvement in cardiovascular disease and hypertensive patients: a systematic review

BACKGROUND AND OBJECTIVES

Cardiovascular diseases (CVD) and hypertension are leading causes of morbidity and mortality worldwide, significantly affecting quality of life (QoL). Stress, anxiety, and poor psychological well-being often exacerbate these conditions, creating a vicious cycle. Relaxation techniques, including progressive muscle relaxation (PMR) and diaphragmatic breathing, assist in contracting and relaxing muscle groups to aid individuals in identifying and reducing physical tension and foster relaxation due to increased parasympathetic nerve activity, resulting in emotional tranquility. This systematic review explores the efficacy of relaxation techniques in reducing stress and improving QoL in patients with CVD and hypertension.

MATERIALS AND METHODS

The review adhered to PRISMA guidelines, searching five major databases (PubMed, EBSCOhost, Web of Science, PsychINFO, and Scopus) with a search time range from 2014 to 2024. This review has been registered on Open OSF (n) 6HYG9.

RESULTS

The results from several studies highlight the positive effects of relaxation techniques on both cardiovascular health and psychological well-being. Various methods, such as PMR, breathing exercises, and biofeedback, significantly reduced blood pressure (BP), anxiety, and stress levels in hypertensive and cardiovascular patients. Additionally, interventions like Benson's relaxation and jaw relaxation demonstrated improvements in patient QoL and cardiovascular health outcomes, underscoring the potential benefits of integrating relaxation techniques into treatment programs for heart-related conditions.

CONCLUSIONS

By targeting both the physiological and psychological aspects of the patient's well-being, these methods contribute to improved BP regulation, reduced heart rate, and alleviation of anxiety and stress symptoms. When incorporated into cardiac rehabilitation programs, these techniques have shown positive effects on emotional well-being and overall QoL, making them a valuable tool for patients recovering from cardiovascular events or managing chronic CVD. More robust, high-quality studies are needed to refine the optimal methods, duration, and frequency of these interventions.

Challenges in blood pressure measurement in children with obesity: focus on the cuff

Childhood obesity is a well-known risk factor for primary hypertension (HTN), especially during puberty. Validated automated oscillometric devices based on universal protocols using proper cuffs according to arm sizes must be selected for blood pressure (BP) measurement in clinical practice. Recent recommendations have addressed the importance of accurate BP measurement in patients with obesity. The American Heart Association (AHA) suggests using a cone-shaped cuff, while the European Society of Hypertension (ESH) emphasizes the significance of cuff characteristics based on arm size. The applicability of cone-shaped cuffs over cylindrical cuffs has been studied in adults with obesity. Most studies focused on the upper arm's shape and provided evidence that the use of cylindrical cuffs may overestimate BP in individuals with obesity, while the conical cuff was proposed as a proper alternative. However, current validation studies for BP measurement devices have not included the arm's size as a recruiting criterion, which may compromise the accuracy of devices in individuals with obesity. This review discusses the role of arm characteristics in cuff selection and the potential role of conical cuffs as an alternative to commonly used cylindrical ones in BP measurement in pediatric patients with obesity.

Is Serum Uric Acid to Creatinine Ratio Associated with Hypertension and Metabolic Syndrome in Children with Obesity?

Childhood obesity is a global health problem with increasing prevalence, leading to long-term cardiovascular complications. Research conducted on adults has established a correlation between serum uric acid to creatinine ratio (SUA/Cr) and metabolic syndrome (MetS) components. The study investigates the relationship between SUA/Cr and hypertension (HT) and MetS components in children with obesity.A total of 103 children with obesity who underwent ambulatory blood pressure measurement (ABPM) were included the study and patients were divided into two groups "HT" (n=60) and "Normal" (n=43). Demographic, anthropometric, and laboratory characteristics were retrospectively analyzed.The study included 103 children (42 female, 61 male) with a mean age of 13.7±2.9 years. HT prevalence was significantly higher in patients with severe obesity and dyslipidemia (p=0.045, p=0.01). Males exhibited significantly higher SUA/Cr than females (p<0.001). However, SUA/Cr showed no significant differences between patients with and without HT, MetS, dyslipidemia, or hyperglycemia (p=0.69, p=0.64, p=0.90, p=0.37). Furthermore, linear regression analysis did not establish a significant effect of SUA/Cr on ABPM parameters (p>0.05).In our cohort, no significant association was found between SUA/Cr and HT, as well as MetS components in children with obesity. These findings highlight the need for further investigation into the complex mechanisms regulating uric acid metabolism, obesity, and cardiovascular risk in children.

Congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency: clinical, biochemical and molecular characteristics and long-term outcomes

INTRODUCTION

11β-hydroxylase (11β-OH) deficiency is the second most frequent cause of classic congenital adrenal hyperplasia (CAH) (5%-8% of cases). Clinically, it is characterized by virilization and arterial hypertension. The objective of this study was to describe the clinical, biochemical and genetic characteristics classic 11β-OH deficiency in patients managed in our hospital and its outcomes.

PATIENTS AND METHODS

Retrospective longitudinal, observational and descriptive study.

INCLUSION CRITERIA

Patients with clinical features of virilization, high levels of 11-deoxycortisol and study of CYP11B1 gene with detection of pathogenic and likely pathogenic variants.

RESULTS

We identified 6 patients (1 male, 5 female) from 4 families. In the 4 index cases, the median age at diagnosis was 2.3 years. The 46,XX patients exhibited a variable degree of virilization at diagnosis, with a predominance of Prader stage V, and one case of male sex assignment at birth. All patients had elevated serum concentrations of 17-hydroxyprogesterone and testosterone. Fifty percent of the patients had developed arterial hypertension during the follow-up, with onset at a median age of 9.3 years. Three 46,XX patients reached a median final height of 154 cm. Six different variants of theCYP11B1 gene were identified, 5 of which were novel variants (c.595 G > A, c.710 T > C, c.1156delG, c.395 + 2dupT, c.1159dupA).

CONCLUSIONS

There is considerable heterogeneity in the clinical presentation of patients with CAH due to 11β-OH deficiency. Early diagnosis and treatment are important to prevent complications and improve long-term outcomes. We report 6 different variants of the CYP11B1 gene, including 5 novel variants.

IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis

IgA nephropathy and IgA vasculitis with nephritis, albeit rare, represent two relatively frequent glomerular conditions in childhood. Compared to adults, pediatric IgA nephropathy has a more acute presentation, most frequently with synpharyngitic macrohematuria and histologically with more intense inflammation and less intense chronic damage. Management of these conditions is controversial and supported by little high-quality evidence. The paucity of evidence is due to the disease heterogeneity, its inter-ethnic variability, and the difficulty of extrapolating data from adult studies due to the peculiarities of the condition in children. IgA vasculitis with nephritis is a kidney manifestation of a systemic disorder, typical of the pediatric age, in which both the diagnosis of kidney involvement and its management are poorly defined, and an interdisciplinary approach is crucial. Both conditions can have a profound and long-lasting impact on kidney function and the global health of affected children. The International Pediatric Nephrology Association has therefore convened a diverse international group of experts from different disciplines to provide guidance on the recommended management of these conditions in children and to establish common definitions and define priorities for future high-quality, evidence-based collaborative studies for the benefit of children.

Subclinical target organ damage in a sample of children and adolescents with solitary functioning kidney. A pilot study

BACKGROUND

Patients with solitary functioning kidney appear to be exposed to an increased cardiovascular risk. This study aimed to evaluate the impact of peripheral and central blood pressure on subclinical cardiovascular organ damage in a sample of children and adolescents with solitary functioning kidney.

METHODS

Carotid ultrasonography was performed to measure the carotid intima-media thickness (cIMT) and the carotid distensibility coefficient. The carotid-femoral pulse wave velocity (PWV) was assessed by tonometry. Cardiac mass and remodeling were estimated using transthoracic echocardiography. Central and peripheral (both office and 24-h ambulatory) BP measurements were collected.

RESULTS

Forty-four patients were included. Eighteen subjects (45%) were hypertensive as assessed by 24-h ABPM, with a prevalence of masked hypertension of 43%. Twenty-three subjects (52%) had an increased cIMT, while 2 and 3 patients (5% and 7%) demonstrated an impaired carotid distensibility coefficient and PWV, respectively. Nineteen subjects (43%) showed concentric cardiac remodeling. Central systolic blood pressure (cSBP) correlated with cIMT (r = 0.35) and left ventricular mass index (LVMi) (r = 0.32) demonstrating a positive independent association with an increased cIMT (odds ratio 1.14, 95% confidence interval 1.01-1.29) in multivariate regression analysis.

CONCLUSION

Children and adolescents with solitary functioning kidney exhibited a high prevalence of masked hypertension and subclinical cardiovascular organ damage. These findings support the use of 24-h ABPM to identify patients with a higher cardiovascular risk who would benefit from hypertension treatment and closer monitoring during growth and into adulthood. Additionally, cSBP measurement should be considered as part of a more detailed cardiovascular risk assessment in these patients.

Systemic inflammation markers and the prevalence of hypertension in 8- to 17-year-old children and adolescents: A NHANES cross-sectional study

BACKGROUND AND AIMS

The recent emphasis on systemic inflammation markers has focused primarily on their association with cardiac disorders, particularly the prevalence of hypertension, in adults but not children and adolescents. This research aimed to explore the associations between systemic inflammation markers and the occurrence of hypertension in 8- to 17-year-old children and adolescents in the United States.

METHODS AND RESULTS

Data from 6095 participants under 18 years of age were obtained from the National Health and Nutritional Examination Survey (NHANES: 1999-2020). This study examined the associations between the incidence of hypertension and four indicators of systemic inflammation: the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). Multivariate logistic regression analysis results are represented as odds ratios (ORs) and 95 % confidence intervals (CIs), and subgroup analyses were conducted to further explore associations. After fully adjusting for potential confounding covariates, the SII, NLR, and PLR were positively associated with hypertension. Compared with individuals in the bottom quartiles, those in the top SII, NLR, and PLR quartiles were 2.12, 2.11, and 1.57 times more likely to have hypertension, respectively. Conversely, the LMR was negatively associated with hypertension incidence, particularly among those in the highest LMR quartiles (OR = 0.59, 95 % CI = 0.39-0.88; P = 0.009). Subgroup analyses revealed that the four indicators exhibited strong correlations with hypertension in male subjects.

CONCLUSION

This study revealed significant relationships between systemic inflammatory markers and hypertension incidence, highlighting the potential of these markers as hypertension risk indicators, particularly among male patients.

Adverse Cardiovascular Risk Profile and Increased Diurnal Salivary Cortisol in Girls With Turner Syndrome: An Exploratory Study

Patients with Turner Syndrome (TS) and those exposed to high concentrations of glucocorticoids have a number of characteristics in common, including an increased risk of cardiovascular disease. Pediatric TS patients underwent studies of salivary cortisol (SC) and cortisone (SCn), body composition, continuous glucose monitoring, vascular function, and ambulatory blood pressure (BP). Biochemical indicators of cardiovascular risk were also measured. Data were compared to matched healthy controls (HCs) or interpreted according to reference populations. Ten patients, aged 14.1 ± 2.3 years participated. Mean SC was higher in girls with TS, although the early morning measurement was lower resulting in a flatter diurnal profile. Body mass index was > 1.0 SDS in five and muscle-to-fat ratio was low (< 0.8) in six participants. Four had proatherogenic lipid profiles and six had raised clotting and/or inflammatory markers. Mean glucose concentration was higher in TS than in HCs (109.8 vs. 102.6 mg/dL, p = 0.003). Loss of nocturnal dipping in BP was universal, and hypertension was present in three patients. TS participants had an adverse cardiovascular profile. The same cohort also exhibited increased cortisol exposure and the clinical significance of these dual findings warrants further investigation.

Feasibility of home blood pressure screening in the paediatric outpatient clinic setting

OBJECTIVE

The aim of this study was to evaluate the acceptability and feasibility of home-based blood pressure (BP) screening in a group of paediatric patients with known elevated risk of developing hypertension.

DESIGN

Cross-sectional study.

SETTING

Specialist outpatient clinic and patient homes.

PATIENTS

52 children and adolescents living with neurofibromatosis type 1.

INTERVENTIONS

Clinic BP measured thrice manually and once via an automated device; home BP measured daily with the same device for 3 days.

MAIN OUTCOME MEASURES

Acceptability and feasibility were assessed with a Children's Anxiety Meter-State score, the comparability of home and clinic BPs, a parental survey, assessment of costs and the device return rate.

RESULTS

Home systolic BP and diastolic BP were statistically similar to both clinic manual (95% CI -4.78 to 0.13; -4.80 to 0.93) and automatic BPs (95% CI -4.44 to 2.08; -0.54 to 5.52). Anxiety scores (95% CI -0.57 to 0.35) were also similar between settings. Participants and their families reported that home BP measurement was easy, took ~10 min and minimally interrupted family life. Families also largely preferred home BP screening (73% 'yes', 23% 'not sure', 3% 'no'), and 90% returned their devices. Families reported substantial costs in attending clinic, which could be reduced with access to this home BP programme.

CONCLUSIONS

Home BP screening was acceptable and feasible, with home BPs comparable to clinic measurements, no associated anxiety and preferred by families. Telehealth with home BP screening is a viable alternative to in-person appointments, which could reduce individual costs, and foster greater equity of care and access to health services.

Elevated septal native T1 time in cardiac magnetic resonance imaging suggesting myocardial fibrosis in young kidney transplant recipients

BACKGROUND

Patients after kidney transplantation (KTx) in childhood show a high prevalence of cardiac complications, but the underlying mechanism is still poorly understood. In adults, myocardial fibrosis detected in cardiovascular magnetic resonance (CMR) imaging is already an established risk factor. Data for children after KTx are not available. This study aimed to explore cardiac function and structure with focus on myocardial fibrosis and associated risk factors in KTx recipients.

METHODS

Forty-six KTx recipients (mean age 16.0 ± 3.5 years) and 46 age- and sex-matched healthy controls were examined with non-contrast CMR imaging. Native T1 time (nT1), a marker for myocardial fibrosis, was measured at the interventricular septum. Other parameters comprised left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS). Multivariable linear regression analyses were used to explore associations with nT1.

RESULTS

Mean nT1 was significantly higher in KTx recipients compared to controls (1198.1 ± 48.8 vs 1154.4 ± 23.4 ms, p < 0.0001). 46% (21/46) had a nT1 above the upper limit of the normal range (mean + 2 standard deviations of controls). KTx recipients showed higher LVMI z-scores (0.1 ± 1.1 vs -0.3 ± 0.7, p = 0.026), higher LVEF (67.3 ± 3.8% vs 65.3 ± 3.6%, p = 0.012), and lower GLS (-19.0 ± 2.1% vs -20.3 ± 2.7%, p = 0.010). Higher systolic blood pressure (ß = 1.284, p = 0.001), LVMI (ß = 1.542, p < 0.001), and LVEF (ß = 3.535, p = 0.026) were associated with longer nT1 only in KTx recipients, but not in controls. Only 2 KTx recipients exhibited left ventricular hypertrophy; however, a total of 18 displayed elevated nT1 with LVMI z-score within the normal range.

CONCLUSION

Our data suggest the presence of cardiac remodeling with myocardial fibrosis in a significant proportion of young KTx recipients. Non-contrast CMR imaging has the potential to visualize early structural cardiac changes and could become an important diagnostic adjunct in the follow-up of KTx recipients. Longitudinal studies are needed to further evaluate the importance of nT1 in early identification of those at high risk for sudden cardiac death allowing to integrate preventive strategies.

The soluble receptor for advanced glycation end products is independently associated with systolic blood pressure values and hypertension in children

BACKGROUND AND AIM

The advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) axis is a pro-inflammatory pathway promoting endothelial dysfunction and vascular remodelling. The soluble RAGE form (sRAGE), by blocking circulating AGE, protects against AGE-induced detrimental effects. We investigated the role of sRAGE as a marker of high blood pressure and hypertension risk in children.

METHODS AND RESULTS

sRAGE was quantified in 284 children/adolescents (mean age (SD) 11.1 (2.5); 52.1 % male) referred for high-normal blood pressure (systolic and/or diastolic values ≥ 90th, but both <95th percentile) or hypertension (systolic and/or diastolic blood pressure ≥95th percentile) and/or other cardiovascular risk factors (excess weight, dyslipidaemia and insulin resistance). In 22.2 % of the sample, systolic and/or diastolic blood pressure values were above the 90th percentile. The prevalence of excess weight (overweight/obesity), central obesity (waist-to-height-ratio >50%), and insulin resistance (HOMA-index ≥90th percentile) was high (82.7 %, 70.8 %, and 70.5 %, respectively). Few children had altered LDL cholesterol, triglyceride, and HDL cholesterol values (15.7 %, 15.4 %, and 13.6 %, respectively). The lowest sRAGE tertile was associated with the highest risk of having hypertension (p = 0.028), obesity (p < 0.001), central obesity (p = 0.007), and insulin resistance (p < 0.001). sRAGE levels were inversely associated with systolic blood pressure (p < 0.01) and BMI (p = 0.022) z-scores and waist-to-height-ratio (p = 0.001). sRAGE values were inversely associated with the presence of hypertension (p = 0.036) and obesity (p = 0.038).

CONCLUSIONS

The independent relationship between sRAGE, systolic blood pressure, and hypertension in children suggests that the AGE-RAGE axis may be altered early in life, and that sRAGE could be a compelling marker for pediatric cardiovascular risk stratification.

Association Between Physical Fitness and Cardiovascular Health in Chilean Schoolchildren from the Metropolitan Region

Background: Cardiovascular diseases increasingly impact youth, with early development of risk factors such as obesity, hypertension, and inadequate nutrient intake. Proper nutrient intake and physical fitness are vital for reducing these risks, especially in pediatric populations. This study explores the connection between physical fitness, metabolic risk, and nutrient status among 1656 Chilean schoolchildren from diverse socio-economic backgrounds. Methods: Anthropometric measures included weight, height, skinfold thickness, waist circumference, and blood pressure. Physical fitness was assessed via handgrip strength, standing long jump, and a six-minute walk test. Nutrient intake was also evaluated, and a composite metabolic risk score was calculated based on waist circumference, skinfolds, and blood pressure. Results: Boys consistently outperformed girls in physical fitness tests, including grip strength and horizontal jump, with differences becoming more pronounced in higher grades and Tanner stages. Girls exhibited higher subcutaneous fat levels and obesity prevalence during later grades, highlighting gender-specific patterns in body composition. Better physical fitness was associated with lower waist circumference, skinfold thickness, and metabolic risk scores. A moderate correlation between aerobic fitness (distance/height) and blood pressure (r = 0.27, p = 0.01) was observed. Z-Score MR analysis revealed that students in the lowest fitness tertile exhibited significantly higher cardiovascular risk profiles compared to their fitter peers. Conclusions: Physical fitness plays a critical role in reducing cardiovascular risk in children. The findings underscore the importance of promoting gender- and age-specific interventions that include both aerobic and strength-based physical activities. Comprehensive school programs focusing on nutrition and physical activity are essential to mitigating cardiovascular risk and promoting long-term health outcomes. Future longitudinal studies are recommended to establish causal relationships and evaluate the impact of targeted interventions.

Clinical guidelines for the diagnosis, evaluation, and management of hypertension for Korean children and adolescents: the Korean Working Group of Pediatric Hypertension

Pediatric hypertension (HTN) is a significant, growing health concern worldwide and also in Korea. Diagnosis, evaluation, and treatment of HTN in Korean children and adolescents are uncertain due to limitations in using the current international guidelines, since the recommendations by the American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH) guidelines differ. Furthermore, these are guidelines for Western youth, who are racially and ethnically different from Koreans. In addition, reference blood pressure values for all pediatric age groups, which are essential for the diagnosis of HTN according to these two guidelines, are absent in Korea. Therefore, HTN guidelines for Korean children and adolescents should be established. The Korean Working Group of Pediatric Hypertension established clinical guidelines for the diagnosis, evaluation, and management of HTN in Korean children and adolescents. These guidelines were based on reported clinical evidence, expert recommendations, and AAP and ESH guidelines. The characteristics of Korean youth and the Korean medical and insurance system were considered during the establishment of the guidelines. By providing recommendations suitable for Korean youth, these guidelines will help in the prevention and management of childhood HTN, thus relieving the burden of cardiovascular disease in adulthood in Korea.

Tracking and Transition Probability of Blood Pressure From Childhood to Midadulthood

Importance

Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.

Objective

To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.

Design, Setting, and Participants

The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).

Exposures

BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.

Main Outcomes and Measures

Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.

Results

This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).

Conclusion and Relevance

Results of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

The Association Between the Dietary Inflammatory Index, Dietary Pattern, and Hypertension Among Residents in the Xinjiang Region

Background: Diet and inflammation are both associated with hypertension. We aimed to investigate the relationship between the dietary inflammation index (DII), dietary patterns, and the risk of hypertension among Xinjiang residents. Methods: A total of 930 residents aged 20-80 from Shihezi and Tumushuk were selected as participants using a stratified whole cluster random sampling method. General demographic information, dietary data, and physical examination results were collected from the participants and DII scores were calculated. Restricted cubic spline was used to analyze the dose-response relationship between the DII and the risk of hypertension. LASSO regression was used to screen dietary factors associated with hypertension. Factor analysis was used to extract dietary patterns. Finally, logistic regression modeling was used to analyze the association between the DII, dietary patterns, and the risk of hypertension. Results: The DII was linearly and positively associated with the risk of developing hypertension. Logistic regression analysis showed that the prevalence of hypertension was 2.23 (95% CI: 1.53, 3.23) and 3.29 (95% CI: 2.26, 4.79) in the T2 and T3 groups, respectively, compared with the T1 group. Riboflavin and folate were associated with the risk of hypertension. In the vegetable-egg dietary pattern, the risk of hypertension was reduced by 33%, 39%, and 37% in groups Q2, Q3, and Q4, respectively, compared with group Q1 (Q2: OR = 0.67, 95% CI: 0.45, 0.99; Q3: OR = 0.61, 95% CI: 0.41, 0.92; Q4: OR = 0.63, 95% CI: 0.42, 0.96). Conclusions: The higher the DII score, the higher the risk of hypertension among residents of Xinjiang. In addition, vegetable-egg dietary patterns can reduce the risk of hypertension. Therefore, local residents should be scientifically instructed to increase their intake of vegetables and eggs.

Efficacy and safety of fenoldopam for the treatment of hypertensive crises in children with kidney disease: a retrospective study

BACKGROUND

Hypertensive crises in children represent critical medical situations characterized by severe hypertension and potential organ damage. Fenoldopam, a dopaminergic medication, offers a viable therapeutic option for managing such clinical scenarios. We aimed to evaluate efficacy and safety of fenoldopam in the management of hypertensive urgencies and emergencies.

METHODS

This retrospective analysis focused on pediatric patients affected by acute or chronic kidney disease, aged 1 month-18 years, admitted to the Pediatric Nephrology and the Pediatric Intensive Care Unit at University-Hospital of Padua, Italy, who presented with a hypertensive crisis treated with fenoldopam between March 2010 and December 2022.

RESULTS

The study included 74 patients with median age 10 years (interquartile range [IQR] 4-15 years) who received 102 fenoldopam infusions. Seventy-two percent were already receiving antihypertensive treatment before admission. In all cases, fenoldopam was associated with a reduction of blood pressure (BP) after 8 h of treatment, but in 87% of patients reduction of the initial mean arterial pressure (MAP) was higher than 25% of calculated drop pressure. MAP normalized in 26% of cases after 24 h and in 35% after 48 h. Occurrence of hypotension was 7%, while hypokalemia was observed in 13% of cases. Patients who presented a MAP reduction not exceeding 25% of calculated drop pressure received a lower median fenoldopam dose (0.2 mcg/kg/min; IQR 0.1-0.2) compared with patients having a MAP reduction > 25% of calculated drop pressure (0.4 mcg/kg/min; IQR 0.2-0.6; p = 0.002).

CONCLUSIONS

Fenoldopam seems effective and safe for the treatment of hypertensive crises in children with kidney disease, at a starting dose of 0.2 mcg/kg/min. Strict BP monitoring is required to identify possible excessive drop pressure in the first hours of infusion.

Longitudinal Associations Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Subclinical Cardiovascular Measures in Chinese Children

INTRODUCTION

The clinical utility of metabolic dysfunction-associated steatotic liver disease (MASLD) in predicting subsequent subclinical cardiovascular damages in pediatric population remains poorly understood.

METHODS

Data on 1,161 Chinese children aged 10-15 years were used to assess the longitudinal associations of MASLD with subsequent subclinical cardiovascular measures.

RESULTS

Compared with relatively healthy children, children with MASLD had abnormal vascular and cardiac structures, along with reduced cardiac diastolic function at the 2-year follow-up. In addition, children with MASLD had a significantly increased risk of high carotid intima-media thickness and left ventricular hypertrophy.

DISCUSSION

These findings support the clinical utility of MASLD in predicting the development of subclinical cardiovascular damages in childhood.

Systemic Inflammation and Oxidative Stress in Childhood Obesity: Sex Differences in Adiposity Indices and Cardiovascular Risk

Background: Systemic inflammation and oxidative stress are fundamental contributors to the onset of conditions related to childhood obesity, such as cardiovascular (CV) diseases. We aimed to assess CV risk in childhood obesity by examining sex differences in adiposity indices, cardiometabolic profiles, inflammation, and oxidative stress biomarkers. We also aimed to assess the potential of the interferon-inducible T-cell alpha chemoattractant (I-TAC/CXCL11) as a novel biomarker. Methods: Eighty children (36 girls) aged 5-18 years with overweight, obesity, or normal weight were analyzed. Fasting blood samples were obtained to assess C-reactive protein (CRP), leukocytes, myeloperoxidase (MPO), adiponectin, monocyte chemoattractant protein-1, superoxide dismutase-1, I-TAC/CXCL11, and a comprehensive cardiometabolic profile, including glucose, lipid, renal, liver, and thyroid function markers. Adiposity indices were determined using bioelectrical impedance analysis (BIA) and anthropometric measures, including BMI, waist-to-hip and waist-to-height ratios, and visceral and subcutaneous fat thickness. Blood pressure (BP) and pulse wave velocity were also evaluated. Results: Girls had less central obesity and fewer CV risk factors than boys, despite having similar total fat mass. Both girls and boys with overweight or obesity showed higher CRP levels. Girls with excess weight had increased leukocyte counts, while boys had elevated MPO levels, which correlated positively with adiposity indices, systolic BP, and homocysteine, and negatively with HDL. I-TAC/CXCL11 levels were similar across groups. Conclusions: Adiposity indices are essential for evaluating CV risk in children and adolescents, with sex differences underscoring the need for tailored approaches. MPO correlated significantly with CV risk markers, supporting its inclusion in routine assessments. I-TAC/CXCL11 warrants further study in childhood obesity.

Kidney Programming and Hypertension: Linking Prenatal Development to Adulthood

The complex relationship between kidney disease and hypertension represents a critical area of research, yet less attention has been devoted to exploring how this connection develops early in life. Various environmental factors during pregnancy and lactation can significantly impact kidney development, potentially leading to kidney programming that results in alterations in both structure and function. This early programming can contribute to adverse long-term kidney outcomes, such as hypertension. In the context of kidney programming, the molecular pathways involved in hypertension are intricate and include epigenetic modifications, oxidative stress, impaired nitric oxide pathway, inappropriate renin-angiotensin system (RAS) activation, disrupted nutrient sensing, gut microbiota dysbiosis, and altered sodium transport. This review examines each of these mechanisms and highlights reprogramming interventions proposed in preclinical studies to prevent hypertension related to kidney programming. Given that reprogramming strategies differ considerably from conventional treatments for hypertension in kidney disease, it is essential to shift focus toward understanding the processes of kidney programming and its role in the development of programmed hypertension.

Safety of erythrocyte transfusion over a short period in pediatric patients assessed using cardiac deformation imaging

Erythrocyte transfusion is a time-consuming process for both health care personnel and patients. This research is aimed at assessing the safety of erythrocyte transfusion over a short period of time in pediatric patients using innovative echocardiographic parameters, such as tissue Doppler imaging and 2D speckle-tracking echocardiography. Twenty pediatric patients with chronic hemolytic anemia were included in the study. Patients with underlying cardiac, renal, or respiratory dysfunction and severe anemia (hemoglobin < 60 g/L) were excluded. The patients were grouped into small cohorts, and erythrocyte transfusion was initiated at 6 ml/kg/h. If tolerated, the rate was progressively increased by 1 ml/kg/h per cohort until reaching 12 ml/kg/h. Symptoms and signs of clinical intolerance and vital signs were evaluated during and following transfusions. Conventional echocardiography, tissue Doppler imaging, and 2D speckle-tracking echocardiography were performed before and after transfusion. No symptoms or signs of clinical intolerance were reported during or after transfusion. Following transfusion, the heart rate decreased significantly (P = 0.018). No significant changes in the systolic or diastolic functions of the right or left ventricles were observed after transfusion. Following transfusion, significant improvements in the ejection times of the left and right ventricles (P = 0.001 and P = 0.007, respectively) were noted. Similarly, the myocardial performance index significantly improved (P = 0.038 and P = 0.046, respectively). Conclusion: This exploratory study addresses the issue of whether erythrocyte transfusion may be administered at up to 12 ml/kg/h in selected stable pediatric patients with chronic anemia without the risk of developing transfusion-associated circulatory overload or affecting cardiac function. In addition to reducing tachycardia, erythrocyte transfusion improves biventricular ejection time and myocardial performance index (Tei-index).

Parent and Primary Care Clinician Perceptions About Pediatric Hypertension

Importance

Despite published guidelines and a prevalence of pediatric hypertension of approximately 3%, less than 25% of affected children are identified, with 60% not receiving any intervention despite detection. Understanding the knowledge and perceptions of parents or caregivers and health care teams is crucial to identify factors that may contribute to these unacceptably low detection rates.

Objective

To examine the knowledge and perceptions of parents and health care teams regarding pediatric hypertension to identify common themes contributing to low hypertension detection.

Design, Setting, and Participants

This qualitative study, interviewed parents of children diagnosed with hypertension who did not follow up within 1 year after diagnosis and health care clinicians (medical assistants, nurses, managers, pediatricians, and nurse practitioners) across 10 clinics in Delaware and Pennsylvania between November 1, 2022, and March 31, 2023.

Main Outcomes and Measures

With the use of an inductive thematic approach, codes were developed and themes identified by multidisciplinary research investigators.

Results

A total of 38 stakeholders (mean [range] age, 43 [25-64] years; 33 [86%] female), including 13 parents and 25 health care clinicians, were interviewed. The parent sample was diverse based on race (5 [46%] Black, 5 [38%] White, and 3 [23%] other race), ethnicity (5 [38%] Hispanic and 8 [62%] non-Hispanic), and Child Opportunity Index (5 [38%] very low or low, 3 [23%] moderate, and 5 [38%] high or very high). Parents and clinicians demonstrated awareness of the significance of pediatric hypertension. Parents thought blood pressure checks were important; however, clinicians often had competing priorities during annual visits. Both groups expressed skepticism about high blood pressure readings, attributing them to situational factors or white coat syndrome. Parents and clinicians shared concerns about medication use and preferred lifestyle change. Parents advocated for further testing, whereas clinicians exhibited varying perspectives on additional diagnostics, emphasizing targeted testing strategies and cautious medication approaches.

Conclusions and Relevance

In this qualitative study of parents and clinicians, both groups were skeptical of blood pressure readings and expressed concerns about medication use, with a preference for lifestyle changes over medication. Improving detection may require better measurement tools, reassurance about medications, and clear communication on the role of nonpharmacologic treatments, while future interventions should incorporate the perspectives of both parents and clinicians to develop practical strategies for managing pediatric hypertension.

Office BP measurement using conical cuffs in children and adolescents with obesity

OBJECTIVE

Findings from adult studies suggest that tronco-conical cuffs provide more accurate blood pressure (BP) measurements in individuals with obesity. The aim of the present study was to examine differences in office blood pressure (BP) levels using conical cuffs compared to standard-shaped cylindrical cuffs in children and adolescents with obesity.

DESIGN AND METHOD

We performed an observational study, including 37 children and adolescents with obesity, who were consequently recruited from the outpatient clinics of the Obesity and Cardiovascular Risk Unit at General University Hospital Consortium of Valencia. Arm circumference AC was measured in all participants, and the appropriate cuff size was selected for both conical and cylindrical cuffs.

RESULTS

Mean participants' age was 11.8± 2.5 years, mean BMI was 28.8± 3.4 kg/m2, mean BMI z-score was 2.12± 0.32, and mean AC was 30.0± 3.6 cm. There was no statistical significance in BP levels measured by cylindrical compared to conical cuffs (mean difference cylindrical-conical cuff was -0.22± 6.55 mmHg for SBP, -0.02± 0.81 for SBP z-score, -0.70± 4.95 mmHg for DBP, and -0.06± 0.44 for DBP z-score). A significant positive association was found between the measurements obtained by cylindrical and conical cuffs in both mean and z-score SBP and DBP values (p < 0.001). Bland-Altman analysis showed good agreement, with 94.6% of the values for all BP parameters lying between the limits of agreement.

CONCLUSIONS

Although the use of conical cuffs in the study showed no advantage in enhancing the performance of BP measurements, they may be considered an alternative for office BP measurements in children and adolescents with obesity. Their reliability should be confirmed in larger populations and different settings.

Serum neutrophil gelatinase-associated lipocalin and cystatin C is associated with blood pressure in ex-preterm children and adolescents

BACKGROUND

As preterm birth is a risk factor for hypertension (HTN), biomarkers for early prediction of HTN in childhood is an emerging need. The aims of the study were to evaluate serum biomarkers in ex-preterm children and examine for associations with office peripheral and central SBP (cSBP), ambulatory BP parameters and pulse wave velocity (PWV).

METHODS

This case-control study included children and adolescents born prematurely (ex-preterms) and at full term (controls). All participants underwent office and ambulatory BP monitoring, assessment of cSBP, PWV and serum biomarkers at the same visit. Neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-2, metalloproteinase-9 (MMP-2, MMP-9) and Cystatin C (CysC) were measured using ELISA.

RESULTS

The study population included 52 ex-preterm individuals and 26 controls. Mean age was 10.7 ± 3.6 years. NGAL, MMP-2, MMP-9, and CysC levels were similar between the ex-preterm and the control group. In the ex-preterm group, NGAL is associated with office SBP z score ( β  = 1.007, 95% CI 1.001-0.014, P  = 0.049), CysC with office DBP z score ( β  = 1.003, 95% CI 1.001-0.005, P  = 0.018) and cSBP z score ( β  = 1.003, 95% CI 1.001-0.005, P  = 0.006) independently of age, sex and BMI z score. Among ex-preterm children and adolescents 17% had ambulatory HTN and 31% had white-coat HTN. NGAL levels were higher in ex-preterm children with WCH compared with children with normal BP [57.9 (IQR 50.8) versus 34.6 (IQR 46.2)], P  = 0.018].

CONCLUSION

WCH is common in ex-preterm children and adolescents and is associated with higher NGAL levels and CysC presents positive association with cSBP. The findings in this study provides preliminary evidence that NGAL and CysC may have a role in predicting the risk of developing hypertension later in life. Further studies are warranted.

HyperChildNET COST Action CA19115: report of the task force

Purpose: Despite dramatic medical advances over the last few decades, cardiovascular disease remains a leading cause of death globally. High BP is clearly established, but modifiable, risk factor for early disability and death. Although most of the adverse outcomes occur in adulthood it has become clear that high BP is a life course problem that can become evident in early life however, relatively little attention has been paid to the problem of high BP in children and adolescents. Materials and methods: Being aware of the problem and the needs, the Task Force of the ESH Guidelines in children and adolescents took the initiative to move forward in the field, identifying the COST Action program. A proposal, HyperChildNET, was submitted, approved and funded for 4 years starting in October 2020. Results: The aim of the Action has been to establish a European sustainable and multidisciplinary network of researchers, clinicians, early career investigators, health economists, decision-makers, regulatory bodies, and medical devices manufacturers under the umbrella of the European Commission in order to acquire a holistic understanding of those factors affecting high BP in children and adolescents in order to propose and implement preventive and corrective actions. All the activities carried out during the 4 years are described. Conclusions: HyperChildNET offers a European perspective of the issue giving us the opportunity to develop new strategies and objectives moving forward in the field.

Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study

Key Points

Among 727 children with posterior urethral valves, 32% had major adverse kidney events (death, kidney failure, or CKD) over a median of 14.2-year follow-up. Children with posterior urethral valves were at substantially higher risks of kidney failure, CKD, and hypertension than the general population. This justifies close kidney health surveillance among children with posterior urethral valves and optimized transitions to adult urologic care.

Background

Posterior urethral valves represent the most common cause of lower urinary tract obstruction in male infants (approximately 1/4000 live births). Long-term kidney outcomes of posterior urethral valves remain uncertain. We aimed to determine the time-varying risk of major adverse kidney events (MAKE) following children with posterior urethral valves into adulthood.

Methods

A population-based retrospective cohort study of all male children (<2 years) diagnosed with posterior urethral valves between 1991 and 2021 in Ontario, Canada. Comparator cohorts were (1 ) male general population and (2 ) male children with pyeloplasty (both <2 years). The primary outcome was MAKE (death, long-term KRT [dialysis or kidney transplant], or CKD). Time to MAKE was analyzed using multivariable-adjusted Cox proportional hazards models. We censored for provincial emigration or administrative censoring (March 31, 2022).

Results

We included 727 children with posterior urethral valves, 855 pyeloplasty comparators, and 1,013,052 general population comparators. The median follow-up time was 16.6 years (Q1–3, 8.6–24.5) overall. Throughout follow-up, 32% of children with posterior urethral valves developed MAKE versus 1% of the general population and 6% of pyeloplasty comparators. Their adjusted hazard ratio for MAKE was 36.6 (95% confidence interval, 31.6 to 42.4) versus the general population. The risk of developing MAKE declined over the first 5 years after posterior urethral valve diagnosis but remained elevated for >30-year follow-up. Children with posterior urethral valves were also at higher risk of death, CKD, long-term KRT, hypertension, and AKI than the general population or pyeloplasty comparators.

Conclusions

Children with posterior urethral valves are at higher risk of adverse long-term kidney outcomes well into adulthood.

Hypertension in children and adolescents: perspectives in Japan

Hypertension in children and adolescents is associated with increased risk of hypertension and cardiovascular disease (CVD) in adulthood. Therefore, preventing hypertension among children and adolescents is an important public health objective worldwide. Although the importance of hypertension in children and adolescents has increasingly been recognized, the field of research is relatively new and evidence for etiologies, prevention and treatment is sparse. This review mainly summarizes the content regarding hypertension in children and adolescents published in Hypertension Research in 2023/24. Highlights include the following: The prevalence of hypertension was higher in female than male Japanese junior high school students (13.7% vs. 4.7%), but there was no significant gender difference among Japanese senior high school students (7.4% vs. 5.4%). Hematological parameters, including red blood cell counts, hemoglobin counts, hematocrit and iron levels, were positively associated with blood pressure (BP) levels in healthy children and adolescents. Higher-risk longitudinal BP trajectories in early life were associated with increased risk of target organ damage (TOD) and higher combined TOD load in midlife. BP phenotypes (e.g., masked hypertension, white-coat hypertension) assessed using office and 24-h ambulatory BP monitoring were not highly reproducible in children. The salt check sheet was a useful tool for evaluating the approximate dietary salt intake in Japanese children and adolescents. It is recommended that healthcare providers screen for hypertension in children and adolescents and recognize the importance of early intervention for those with elevated BP levels. Beginning in childhood, continuous education on hypertension and proper dietary salt intake are key to reducing the risk of hypertension and decreasing the burden of CVD in adulthood.