Comparison of echocardiographic changes in children with primary hypertension and hypertension due to mild to moderate chronic kidney disease
Chronic systemic hypertension has a well-known association with increased cardiovascular morbidity and mortality. One of the most important target organs affected in systemic hypertension is the heart. In addition, chronic kidney disease (CKD) further increases the mortality from cardiovascular disease. The aim of this study was to evaluate the differences in the cardiovascular changes in pediatric patients with primary hypertension (pHTN) vs. those with secondary hypertension from chronic kidney disease (CKD-HTN).
This was a retrospective chart review of patients with CKD-HTN and pHTN. The medical records were reviewed for anthropometric data, biochemical assessment of renal function, and for cardiovascular changes on echocardiogram.
Twenty-three patients with pHTN and 29 patients with CKD-HTN were included in the study. There were no differences in age, gender, weight, height, body mass index, and blood pressure between the 2 groups. There was a high prevalence of left ventricular diastolic dysfunction among both the groups (CKD-HTN 25 vs. pHTN 26%). Reduced mitral valve inflow Doppler E/A ratio, a marker of left ventricular diastolic dysfunction in echocardiogram, was more pronounced in CKD-HTN patents, in comparison to those with pHTN (p = 0.042). Also, diastolic function worsened with declining glomerular filtration rate in patients with CKD-HTN. Similarly, patients with CKD-HTN had a larger aortic root dimension when compared to patients with pHTN (p = 0.049).
The prevalence of left ventricular diastolic dysfunction is similar in patients with pHTN and CKD-HTN. Patients with CKD-HTN appear to have more severe diastolic dysfunction and larger aortic root dimensions.
KeywordsChronic kidney disease Secondary hypertension Primary hypertension Echocardiogram Children
Dr. Paris and Dr. Arenas-Morales performed the data collection, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Gorla critically reviewed and approved the final manuscript as submitted. Dr. Swaminathan and Dr. Seeherunvong have equally contributed to the manuscript preparation. Both together, conceptualized and designed the study, supervised the data collection and statistical analysis, edited, approved, and revised the final manuscript as submitted.
Compliance with ethical standards
This was a retrospective chart review and was approved by the Institutional Review Board of Human Subjects Research at the University of Miami and Holtz Children’s Hospital.
The authors have no financial relationships relevant to this manuscript to disclose.
Conflict of interest
All authors declared that they have no conflicts of interest.
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