Assessment of the state of heart and kidney as target organs in hypertensive children

Abstract

Purpose — to assess the functional state of target organs in hypertensive children.
Patients and methods. We examined 41 hypertensive adolescents (aged from 13 to 17) who had been under treatment at Vinnitsa regional children`s hospital. The patients were grouped by stage of hypertension — 66% of children had stage 1 (n=27) and 34% had stage 2 (n=14), clinical form — 73% with labile hypertension (n=30) and 27% with stable (n=11). Also patients were divided by body mass index — 46% had normal weight (n=19), 19% were overweight (n=6) and 39% were obese (n=16). The control group consisted of 30 practically healthy children aged from 13 to 17. In order to assess the functional state of target organs anamnestic, clinic-instrumental (cardiac echo, ambulatory blood pressure monitoring), laboratory (albuminuria) and statistical methods (the student`s t-test, fisher's method and odds ratio) were used.
Results. In hypertensive children left ventricular posterior wall thicknesses (9.92±0.22 mm), interventricular septum thicknesses (9.8±0.2 mm) and left ventricular mass index (75.98±1.83 g/m2) were significantly higher (Р<0.05) than in healthy children from the control group (7.44±0.2 mm, 7.7±0.2 mm, 60.14±1.40 g/m2, respectively). Left ventricular posterior wall thicknesses in children with stable form (10.6±0.5 mm), stage 2 of hypertension (10.7±0.3 mm) — as well as obese patients (10.53±0.3 mm) — was significantly higher (P<0.05) than in children with labile (9.4±0.2 mm) and stage 1 of hypertension (9.5±0.3 mm), and also normal weight and overweight children (9.5±0.31 mm and 9.5±0.58 mm, respectively). Interventricular septum thicknesses in those children who had stable form (10.5±0.5 mm), stage 2 of hypertension (10.5±0.3 mm) — as well as obese patients (10.43±0.32 mm) — was significantly higher (P<0.05) than in children with labile (9.4±0.2 mm) and stage 1 of hypertension (9.5±0.3 mm), and also normal weight and overweight children (9.38±0.29 mm and 9.45±0.4 mm, respectively). The average children`s level of microalbuminuria at the studied group (22.92±1.96 mg/L) was more than twice higher (P<0.05), than in healthy children from the control group (10.23±1.49 mg/L). Patients with stable form (31.3±4.8 mg/L) and stage 2 of hypertension (28.3±3.1 mg/L), and also obese children (29.96±3.52 mg/L), had more than 1,5 times higher levels of microalbuminuria (p<0.05) than patients with labile form (19.8±1.8 mg/L), stage 1 of hypertension (20.1±2.0 mg/L), normal weight and overweight children (18.33±2.28 mg/L and 18.66±2.93 mg/L, respectively. Odds ratio calculation helped to determine that stage 2 (OR=5.867; 95% CI: 1.018–16.936) and stable form of hypertension (OR=3.943; 95% CI: 1.395–24.693) increased the risk of left ventricle hypertrophy almost in 6 and 4 times, respectively, and microalbuminuria (OR=3.5; 95% CI: 1.875–13.995 for stage 2 of hypertension and OR=4.813; 95% CI: 1.105–20.952 for stable form) in 3,5 and 5 times, respectively, comparing to stage 1 and labile hypertension.
Conclusions. Target organ damage in hypertensive patients develops as early as in childish age, but not followed by significant clinical symptoms, and intensity of this damage depends on severity and clinical form of hypertension. Body mass index over 30 kg/m2 is an additional factor causing negative influence on target organs. The study shows the importance of early target organ damage detection in hypertensive children and adolescents, for better management of the disease and life quality and quantity elevation.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee (LEC) of participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors.