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Our study aimed to assess active renin concentration in children with primary hypertension. Thus, we evaluated active renin concentration, clinical parameters, office and ambulatory blood pressure, and biochemical parameters in 51 untreated adolescents with primary hypertension (median: 14.4 [interquartile range-IQR: 13.8-16.8] years) and 45 healthy adolescents. Active renin concentration did not differ between patients with hypertension and healthy children (median: 28.5 [IQR: 21.9-45.2] vs. 24.9 [IQR: 16.8-34.3] [pg/mL], p = 0.055). In the whole group of 96 children, active renin concentration correlated positively with serum potassium and office and ambulatory systolic and diastolic blood pressures. Among children with hypertension, patients with isolated systolic hypertension had lower renin concentration than patients with systolic-diastolic hypertension (26.2 [IQR: 18.6-34.2] vs. 37.8 [IQR: 27.0-49.6] [pg/mL], p = 0.014). The active renin concentration did not differ between patients with isolated systolic hypertension and healthy children. In multivariate analysis, diastolic blood pressure Z-score (beta = 0.238, 95 confidence interval [0.018-0.458], p = 0.035) was the only predictor of active renin concentration in the studied children. We concluded that active renin concentration is positively associated with blood pressure and potassium in children, and diastolic blood pressure was the strongest predictor of renin level. Patients with isolated systolic hypertension may differ from patients with systolic-diastolic hypertension in less severe activation of the renin-angiotensin-aldosterone system.

Increased concentration of uric acid may play a role in the pathogenesis of primary hypertension (PH)., Aim: The aim of the study was to assess concentration of uric acid and to assess its correlation with selected clinical and biochemical parameters in children with PH., Materials and Methods: In a group of 57 untreated pharmacologically children with PH (44 boys, 13 girls, mean age 14.99±2.84 years) following parameters were assessed: serum uric acid concentration, blood pressure in office measurement and in 24-hour ambulatory blood pressure monitoring (ABPM), and selected clinical and biochemical parameters. Control group consisted of 20 healthy children (mean 14.11±2.99 years)., Results: Serum uric acid concentration was significantly higher in children with PH compared to healthy children (5.72±1.38 vs. 4.55±1.07 mg/dL; p=0.001). In patients with PH, its concentration was significantly higher in boys compared to girls ((6.12±1.20 mg/dL vs. 4.35±1.13 mg/dL, p<0.001), no such difference was found in healthy children. In the PH group, uric acid concentration correlated positively with age (r=0.426, p=0.001), height (r=0.557, p<0.001), weight (r=0.518, p<0.001), weight Z- score (r=0.296, p=0.025), BMI (r=0.316, p=0.017), neutrophil count (r=0.280, p=0.035), systolic blood pressure (r=0.375, p=0.004) and pulse pressure (r=0.444, p=0.001) in ABPM and negatively with HDL cholesterol, heart rate (r=-0.310, p=0.02 (1=-0.309, p=0.020) and nighttime diastolic blood pressure dip (r=-0.268, p=0.044) in ABPM. In multivariate analysis, the determinants of uric acid concentration in children with PH were sex (Β = 0,367, 95%CI(0.122-0.611), p=0.004) and weight Z-score (Β= 0.254, 95%CI(0.005-0.504), p=0.046)., Conclusions: Children with PH have increased serum uric acid concentration compared to healthy children. The risk factors for hyperuricemia in pediatric patients with PH are male sex and high body weight., (© 2021 MEDPRESS.)

Our study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). The study included 112 children (14.7 ± 2.1 age, 79 boys, 33 girls) with untreated PH. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%, and a nocturnal drop >20% was defined as extreme dipping. The nocturnal SBP drop was 10.9 ± 5.9 (%), and the DBP drop was 16.2 ± 8.5 (%). Non-dipping was found in 50 (44.6%) children and extreme dipping in 29 (25.9%) patients. The nocturnal SBP decrease correlated with BMI Z-score (r = −0.242, p = 0.010) and left ventricular mass index (LVMI) (r = −0.395, p = 0.006); diastolic DBP decrease correlated with augmentation index (AIx75HR) (r = 0.367, p = 0.003). Patients with a disturbed blood pressure profile had the highest LVMI (p = 0.049), while extreme dippers had the highest augmentation index (AIx75HR) (p = 0.027). Elevated systolic and diastolic BP dipping were risk factors for positive AIx75HR (OR 1.122 95CI (1.009–1.249) and OR 1.095 95CI (1.017–1.177). We concluded that disturbed circadian BP profile was common in children with PH and should not be considered a marker of secondary hypertension. A disturbed circadian BP profile may be associated with higher body weight. In pediatric patients with PH, non-dipping is associated with increased left ventricular mass, and extreme dipping may be a risk factor for increased arterial stiffness. [ABSTRACT FROM AUTHOR]

Primary hypertension (PH) is the most common cause of arterial hypertension in adolescents; many of these patients present with isolated systolic hypertension (ISH). The study presents a case of a 16-year-old male adolescent with PH. The patient had ISH in both 24-hourambulatory and office measurements. Secondary causes and hypertension-mediated organ damage were excluded. Evaluation of the vascular phenotype revealed low central systolic blood pressure (109 mm Hg), high peripheral augmentation index (27 mm Hg), and high arterial elasticity. The boy was started on non-pharmacological treatment. The manuscript discusses up-to-date knowledge on the pathogenesis and evolution of ISH in young people. A diagnostic and therapeutic approach according to the European Society of Hypertension is presented. Adolescents with ISH require evaluation of the vascular phenotype. There is a need for further studies on the evolution and long-term outcome in young people with this form of arterial hypertension. [ABSTRACT FROM AUTHOR]

Background: Circulating calcification inhibitors: fetuin A (FA) and osteoprotegerin (OPG) together with soluble ligand of receptor activator of nuclear factor kappa-B (sRANKL) have been linked to vascular calcifications and arterial damage. This study aimed to evaluate relationships between FA, OPG, sRANKL, and arterial damage in children with primary hypertension (PH). Methods: In this cross-sectional single-center study, calcification inhibitors (FA, OPG, sRANKL) levels were measured in blood samples of 60 children with PH (median age 15.8, IQR: [14.5–16.8] years) and 20 age-matched healthy volunteers. In each participant, peripheral and central blood pressure evaluation (BP) and ambulatory BP monitoring (ABPM) were performed. Arterial damage was measured using common carotid artery intima media thickness (cIMT), pulse wave velocity (PWV), augmentation index (AIx75HR), and local arterial stiffness (ECHO-tracking—ET) analysis. Results: Children with PH had significantly higher peripheral and central BP, BP in ABPM, thicker cIMT, higher PWV, and AIx75HR. FA was significantly lower in patients with PH compared to healthy peers without differences in OPG, sRANKL, and OPG/sRANKL and OPG/FA ratios. In children with PH, FA level correlated negatively with cIMT Z-score and ET AIx; sRANKL level correlated negatively with ABPM systolic blood pressure (SBP), SBP load, diastolic BP load, and AIx75HR; OPG/sRANKL ratio correlated positively with SBP load, while OPG/FA ratio correlated positively with ET AIx. In multivariate analysis, FA was a significant determinant of cIMT (mm) and cIMT Z-score. Conclusions: This study reveals that in children with primary hypertension, arterial damage is related to lower fetuin A concentrations. [ABSTRACT FROM AUTHOR]

Background. Children with chronic kidney disease (CKD) are characterized by increased risk of hypertension and chronic low-grade inflammation. The aim of the study was the analysis of relation between parameters of ambulatory blood pressure monitoring (ABPM) and subclinical inflammation in children with CKD. Material and methods. Study group included 27 paediatric patients (age 14.23 ± 3.57 years) with CKD stage 2-5; 18 children with previously recognized hypertension. In all patients we evaluated ABPM, office blood pressure, complete blood count and selected clinical and biochemical parameters. Results. In the study group, GFR was from 7.05 to 86.73, mean 40.88 ± 25.82 mL/min/1.73 m2. All 9 children without hypertension had normal blood pressure in ABPM, but ABPM detected poor blood pressure control in 7 among 18 (38.9%) children with previously recognized and treated hypertension. Abnormal circadian blood pressure profile was found in 12 (44.4%) children: 9/18 (50.0%) with hypertension and 3/9 (33.3%) with normal BP. Systolic, diastolic, mean blood pressure and diastolic blood pressure load correlated with neutrophil count, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (r = 0.39-0.49, p = 0.010-0.044); diastolic and mean blood pressure and diastolic blood pressure load with parathormone (r = 0.48-0.57, p = 0.005-0.023); diastolic blood pressure load with phosphate and calcium-phosphorus product (r = 0.44-0.47, p = 0.021-0.030); diastolic blood pressure dipping with phosphate (r = -0.43, p = 0.034). Conclusions. 1. Ambulatory blood pressure monitoring should be used in children with chronic kidney disease on a regular basis, especially in those with arterial hypertension. 2. Blood pressure in children with chronic kidney disease may be related to degree of subclinical inflammation. [ABSTRACT FROM AUTHOR]

Recent studies showed the significance of the canonical Wnt/beta-catenin pathway and its inhibitor—sclerostin, in the formation of arterial damage, cardiovascular morbidity, and mortality. The study aimed to assess serum sclerostin concentration and its relationship with blood pressure, arterial damage, and calcium-phosphate metabolism in children and adolescents with primary hypertension (PH). Serum sclerostin concentration (pmol/L) was evaluated in 60 pediatric patients with PH and 20 healthy children. In the study group, we also assessed calcium-phosphate metabolism, office peripheral and central blood pressure, 24 h ambulatory blood pressure, and parameters of arterial damage. Serum sclerostin did not differ significantly between patients with PH and the control group (36.6 ± 10.6 vs. 41.0 ± 11.9 (pmol/L), p = 0.119). In the whole study group, sclerostin concentration correlated positively with height Z-score, phosphate, and alkaline phosphatase, and negatively with age, peripheral systolic and mean blood pressure, and central systolic and mean blood pressure. In multivariate analysis, systolic blood pressure (SBP) and height expressed as Z-scores were the significant determinants of serum sclerostin in the studied children: height Z-score (β = 0.224, (95%CI, 0.017–0.430)), SBP Z-score (β = −0.216, (95%CI, −0.417 to −0.016)). In conclusion, our results suggest a significant association between sclerostin and blood pressure in the pediatric population. [ABSTRACT FROM AUTHOR]

Introduction: the immune system can trigger an inflammatory process leading to blood pressure elevation and arterial damage. the aim of the study was to assess the relation between subclinical inflammation and arterial damage in pediatric patients with primary hypertension (PH) and to establish the usefulness of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios, and mean platelet volume (MPV) as markers of arterial damage in these subjects. Material and methods: in 119 children with Ph (14.94 ±2.76 years) and 45 healthy children (14.91 ±2.69 years) we analyzed markers of subclinical inflammation (NLR, PLR, MPV), clinical and biochemical parameters, office blood pressure, ambulatory blood pressure monitoring (ABPM), central blood pressure, aortic pulse wave velocity (APWV), augmentation index corrected for heart rates 75 (aix75hr), carotid intima media thickness (CIMt), and common carotid artery stiffness (e-tracking). Results: Children with Ph were characterized by significantly higher neutrophil (3.9 ±1.7 vs. 3.0 ±1.0 [1000/μl], p < 0.001) and platelet counts (271.9 ±62.3 vs. 250.3 ±60.3 [1000/μl], p = 0.047), nLr (1.9 ±1.5 vs. 1.3 ±0.4, p = 0.010), PLr (131.4 ±41.9 vs. 114.7 ±37.6, p = 0.020), aPwV (5.36 ±0.88 vs. 4.88 ±0.92 m/s, p = 0.004), and ciMt (0.46 ±0.07 vs. 0.43 ±0.07 mm, p = 0.002) compared to healthy children. in Ph children nLr correlated positively (p < 0.05) with: systolic, diastolic and mean blood pressure in ABPM (r = 0.243, r = 0.216, r = 0.251), aPwV [m/s] (r = 0.241), aPwV z-score (r = 0.204), and common carotid artery PWVbeta [m/s] (r = 0.202). Conclusions: there is a link between arterial stiffness and subclinical inflammation in pediatric patients with primary hypertension. Neutrophil-to-lymphocyte ratio may serve as a promising marker of arterial stiffness in pediatric patients affected by primary hypertension. [ABSTRACT FROM AUTHOR]