Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Left Ventricular Hypertrophy and Prelude to Hypertensive Cardiovascular Diseases: from the Pediatric Cardiologist's Point of View

좌심실 비대와 고혈압성 심혈관 합병증: 소아 심장 의사의 관점

  • Cho, Min-Jung (Department of Pediatrics, Pusan National University Hospital)
  • 조민정 (부산대학교병원 소아청소년과)
  • Received : 2011.03.25
  • Accepted : 2011.04.13
  • Published : 2011.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Although left Left ventricular hypertrophy (LVH) is not only an adaptive response of the heart to increased cardiac workload in hypertension, it surelybut also is the most potent risk factor of overt cardiovascular complications such as coronary heart disease, heart failure, arrhythmia and stroke in the hypertensive population. Also it has become generally accepted that subclinical cardiovascular disease begins in childhood and LVH is the most readily assessed marker for that. As LVH can be seen in children and adolescents with even mild blood pressure elevation with the reported prevalence of 10 to 47%, aggressive antihypertensive treatment is critical in preventing the development of hypertensive heart disease in that those cases.

좌심실 비대는 심부전, 허혈성 심질환, 부정맥과 같은 심혈관계 질환의 이환율 및 사망률을 높이는 강력한 위험 인자이며 고혈압으로 초래되는 가장 초기 단계의 심장 변화 이기도 하다. 소아청소년 고혈압 환자들은 분명한 심혈관계 합병증 보다는 무증상의 좌심실 비대만 볼 수 있는 경우가 대부분이나 치료하지 않는 경우 성인에서의 심혈관 합병증으로 이행될 위험이 크다. 표적장기 손상의 가장 대표적인 증거이기도 한 좌심실 비대는 소아청소년에서 고혈압 전 단계 상태에서도 나타나므로 고혈압의 진단 당시와 추후의 추적 진료 중 정기적으로 심초음파를 통한 좌심실 질량의 측정이 이루어 져야 한다. 좌심실 비대가 보인다면 적극적인 약물 치료가 또한 이루어져야 한다.

Keywords

References

  1. Daniels SR, Loggie JM, Khoury P, Kimball TR. Left ventricular geometry and severe left ventricularhypertrophy in children and adolescents with essential hypertension. Circulation 1998;97:1907-11. https://doi.org/10.1161/01.CIR.97.19.1907
  2. Hanevold C, Waller J, Daniels S, Portman R, Sorof J, Association IPH. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 2004;113:328-33. https://doi.org/10.1542/peds.113.2.328
  3. McGonigle LF, Beaudry MA, Coe JY. Recovery from neonatal myocardial dysfunction after treatment of acute hypertension. Arch Dis Child 1987;62:614-5. https://doi.org/10.1136/adc.62.6.614
  4. Hawkins KC, Watson AR, Rutter N. Neonatal hypertension and cardiac failure. Eur J Pediatr 1995;154:148-9. https://doi.org/10.1007/BF01991920
  5. Gradman AH, Alfayoumi F. From left ventricular hypertrophy to congestive heart failure: management of hypertensive heart disease. Prog Cardiovasc Dis 2006;48:326-41. https://doi.org/10.1016/j.pcad.2006.02.001
  6. Laurent GJ. Dynamic state of collagen: pathways of collagen degradation in vivo and their possible role in regulation of collagen mass. Am J Physiol 1987;252:1-9. https://doi.org/10.1152/ajpcell.1987.252.1.1-b
  7. Rosendorff C. The renin-angiotensin system and vascular hypertrophy. J Am Coll Cardiol 1996;28:803-12. https://doi.org/10.1016/S0735-1097(96)00251-3
  8. Roger VL, Weston SA, Redfield MM, Hellermann- Homan JP, Killian J, Yawn BP, et al. Trends in heart failure incidence and survival in a community-based population. JAMA 2004;292:344-50. https://doi.org/10.1001/jama.292.3.344
  9. Sasaki N, Joashi UC, Vergara M, Saland JM, Love BA. Postrenal biopsy AVM leading to severe hypertension and dilated cardiomyopathy. Pediatr Nephrol 2009;24:2459-62. https://doi.org/10.1007/s00467-009-1268-9
  10. Kelley SR, Goel TK, Smith JM. Pheochromocytoma presenting as acute severe congestive heart failure, dilated cardiomyopathy, and severe mitral valvular regurgitation: a case report and review of the literature. J Surg Educ 2009;66:96-101. https://doi.org/10.1016/j.jsurg.2008.11.004
  11. Giles TD. Assessment of global risk: a foundation for a new, better definition of hypertension. J Clin Hypertens (Greenwich) 2006;8(8 Suppl 2):5-14.
  12. Brown DW, Giles WH, Croft JB. Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension. Am Heart J 2000;140:848-56. https://doi.org/10.1067/mhj.2000.111112
  13. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-6. https://doi.org/10.1056/NEJM199005313222203
  14. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: The Muscatine Study. Circulation 2001;104:2815-9. https://doi.org/10.1161/hc4601.099486
  15. Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338:1650-6. https://doi.org/10.1056/NEJM199806043382302
  16. Dawson JD, Sonka M, Blecha MB, Lin W, Davis PH. Risk factors associated with aortic and carotid intima-media thickness in adolescents and young adults: the Muscatine Offspring Study. J Am Coll Cardiol 2009;53: 2273-9. https://doi.org/10.1016/j.jacc.2009.03.026
  17. Stabouli S, Kotsis V, Rizos Z, Toumanidis S, Karagianni C, Constantopoulos A, et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol 2009;24: 1545-51. https://doi.org/10.1007/s00467-009-1165-2
  18. Sorof JM, Alexandrov AV, Cardwell G, Portman RJ. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics 2003;111:61-6. https://doi.org/10.1542/peds.111.1.61
  19. Mitsnefes MM, Daniels SR, Schwartz SM, Khoury P, Strife CF. Changes in left ventricular mass in children and adolescents during chronic dialysis. Pediatr Nephrol 2001;16:318-23. https://doi.org/10.1007/s004670000557
  20. White WB, Dey HM, Schulman P. Assessment of the daily blood pressure load as a determinant of cardiac function in patients with mild-to-moderate hypertension. Am Heart J 1989;118:782-95. https://doi.org/10.1016/0002-8703(89)90593-0
  21. Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990;81:528-36. https://doi.org/10.1161/01.CIR.81.2.528
  22. Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 2004; 144:7-16. https://doi.org/10.1016/j.jpeds.2003.09.050
  23. Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 2002;39:903-8. https://doi.org/10.1161/01.HYP.0000013266.40320.3B
  24. Cuspidi C, Macca G, Sampieri L, Fusi V, Severgnini B, Michev I, et al. Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients. J Hypertens 2001;19:1539-45. https://doi.org/10.1097/00004872-200109000-00004
  25. Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens 2004;22: 273-80. https://doi.org/10.1097/00004872-200402000-00010
  26. Belsha CW, Wells TG, McNiece KL, Seib PM, Plummer JK, Berry PL. Influence of diurnal blood pressure variations on target organ abnormalities in adolescents with mild essential hypertension. Am J Hypertens 1998;11:410-7. https://doi.org/10.1016/S0895-7061(98)00014-4
  27. McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T, et al. Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension 2007;50:392-5. https://doi.org/10.1161/HYPERTENSIONAHA.107.092197
  28. Adolescents NHBPEPWGoHBPiCa. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114(2 Suppl 4th Report):555-76. https://doi.org/10.1542/peds.114.2.S2.555
  29. Ramaswamy P, Patel E, Fahey M, Mahgerefteh J, Lytrivi ID, Kupferman JC. Electrocardiographic predictors of left ventricular hypertrophy in pediatric hypertension. J Pediatr 2009;154:106-10. https://doi.org/10.1016/j.jpeds.2008.07.005
  30. Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr 2008;152: 73-8. https://doi.org/10.1016/j.jpeds.2007.05.053
  31. Dahlof B, Pennert K, Hansson L. Reversal of left ventricular hypertrophy in hypertensive patients. A metaanalysis of 109 treatment studies. Am J Hypertens 1992;5:95-110. https://doi.org/10.1093/ajh/5.2.95
  32. Klingbeil AU, Schneider M, Martus P, Messerli FH, Schmieder RE. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003;115:41-6. https://doi.org/10.1016/S0002-9343(03)00158-X
  33. Gonzalez A, Lopez B, Ravassa S, Querejeta R, Larman M, Diez J, et al. Stimulation of cardiac apoptosis in essential hypertension: potential role of angiotensin II. Hypertension 2002;39:75-80. https://doi.org/10.1161/hy0102.100788
  34. Lopez B, Querejeta R, Varo N, Gonzalez A, Larman M, Martinez Ubago JL, et al. Usefulness of serum carboxy-terminal propeptide of procollagen type I in assessment of the cardioreparative ability of antihypertensive treatment in hypertensive patients. Circulation 2001;104:286-91. https://doi.org/10.1161/01.CIR.104.3.286
  35. Diez J, Querejeta R, Lopez B, Gonzalez A, Larman M, Martinez Ubago JL. Losartandependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation 2002;105:2512-7. https://doi.org/10.1161/01.CIR.0000017264.66561.3D
  36. Sen S, Tarazi RC, Bumpus FM. Reversal of cardiac hypertrophy in renal hypertensive rats: medical vs. surgical therapy. Am J Physiol 1981;240:408-12.
  37. Gaddam KK, Verma A, Thompson M, Amin R, Ventura H. Hypertension and cardiac failure in its various forms. Med Clin North Am 2009;93:665-80. https://doi.org/10.1016/j.mcna.2009.02.005