|Abstract:||Background: Arterial hypertension (AH) and atherosclerosis are the most common diseases of the cardiovascular system in adults, AH being one of the main risk factors for the development of cardiovascular diseases. Following an increase in obesity among children and adolescents, essential hypertension (EH) has become of the most frequent chronic diseases in youth. AH is linked with initial damage to the hypertensive target organs and the development of cardiovascular diseases. Although manifestations of cardiovascular diseases are rare in children, numerous studies show that the process of atherosclerosis begins in childhood. AH is among the cardiovascular disease risk factors that accelerate the process of atherosclerosis. In order to prevent or at least mitigate the development of cardiovascular diseases, it is important to diagnose and treat the diseases and early changes. This applies in particular to the child population, where studies aim to investigate the earliest possible indicators of hypertensive damage and the presence of other apparent cardiovascular risk factors.
Methods: The study comprised 100 children of both genders who were treated at the Department of Pediatrics, University Medical Centre Maribor. They all had three consecutive high blood pressure (BP) readings in different situations, readings that were confirmed by 24-hour monitoring of BP; all were diagnosed with EH. The control group consisted of 50 healthy children of comparable gender and age with normal BP. A detailed clinical examination was carried out, and the patients’ medical history was evaluated; in addition, the eye fundus was examined in the test group. Body weight, height as well as waist and hip circumference were determined for each individual. The results were used to calculate the body mass index (BMI). A standard blood test procedure was used to determine the, totally blood count, C- ractive protein (CRP), urea, creatinine, uric acid, electrolytes, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose, homocysteine, apolipoproteins A1 (apo A1) and B (apo B), lipoprotein (a), insulin and microalbumin in the urine. Adiponectin and leptin levels were determined with a quantitative sandwich enzyme immunoassay technique and ghrelin with the sandwich ELISA method. The fibrinogen level was determined with a modified Clauss method. PAI-1 was determined by chromatography. The intima-media thickness (IMT) of the carotid arteries and the left ventricular mass (LVM) were measured by ultrasound in all children, and arterial compliance (PWV) was determined with applanation tonometry.
Results: Statistically significant differences in body weight (p<0.001), waist circumference (p<0.001), the waist-hip ratio (p<0.001) and the BMI (p<0.001) were established between children with EH and the control group. Children with EH had significantly higher LDL cholesterol (p=0.032), triglycerides (p=0.011), insulin (p<0.001), uric acid (p= 0.002) and glucose (p=0.003) levels, while HDL cholesterol (p= 0.017) and apo A1 (p= 0.008) levels were lower. With respect to adipokines, statistically significant difference could only be proven in the case of adiponectin (p< 0.010).
All morphological examination values were also higher in children with EH; however, statistically significant differences were confirmed only in the case of LVM (p<0.001), the left ventricular posterior wall thickness (<0.001), the interventricular septum thickness (p<0.003), IMT right (p<0.001) and IMT left (p<0.001), while the groups did not differ statistically with respect to the PWV values. Nevertheless, the group with EH had statistically higher values of some other indirect signs of reduced arterial compliance, such as the aortic pulse pressure (AoPP) (p<0.001) and the augmentation index corrected for heart rate 75 b. p. m. (Alx@HR 75) (p=0.044).|