Are the Classical Symptoms of Hypertension in Children Still Sensitive Enough?

The available literature is scarce on the initial symptoms of arterial hypertension in children. Our study aimed to analyze the initial clinical profile of patients referred to the hospital with suspected hypertension and those diagnosed with hypertension for the first time during a hospitalization for other reasons. This study was a retrospective analysis of medical records in 471 patients. More than half of the patients showed no symptoms. The most common symptom reported was a headache-28% (132) of patients. The diagnosis of elevated blood pressure or hypertension was more frequent in asymptomatic patients (P = 0.001). Headaches were seen more often in healthy patients than in patients with hypertension. Newly diagnosed hypertension is mainly diagnosed in asymptomatic children. Moreover, the symptoms previously described in the literature as the most common did not prove to be predictive of hypertension in our study.

Lipid Profile in Children Born Small for Gestational Age.

BACKGROUND: Lipid disorders are one of the risk factors for cardiovascular diseases. The aim of the study was to estimate the lipid profile in early childhood in the population of Polish children born small for gestational age (SGA). MATERIALS AND METHODS: The study included 140 patients (93 SGA children and 47 controls) aged 5 to 11 years. All the subjects underwent a physical examination and blood laboratory tests for the glucose and lipid profiles. The SGA group was divided into subgroups, i.e., symmetrical and asymmetrical intrauterine growth restriction (IUGR). RESULTS: Blood sample analysis revealed higher levels of total cholesterol (SGA group 190.61 ± 24.66 mg/dL vs. controls 143.23 ± 23.90; p < 0.001). The analysis of particular cholesterol fractions showed significantly higher mean values of triglycerides and LDL cholesterol as well as lower mean values of HDL cholesterol in SGA children. Children in both groups did not differ significantly in terms of weight or body mass index. A statistically significantly higher glucose concentration was observed in SGA patients with the symmetrical type of IUGR. Analyzing the differences regarding metabolic factors, we obtained a statistically significant difference only in fasting glucose concentration (asymmetrical IUGR = 90.56 ± 10.21 vs. symmetrical IUGR = 98.95 ± 14.79; p < 0.001). CONCLUSIONS: Children born SGA, even those not suffering from overweight or obesity in their early childhood, have an abnormal lipid profile, which may contribute to the development of cardiovascular diseases in adulthood.

Assessment of Cardiovascular Risk Factors in Patients with Juvenile Idiopathic Arthritis.

INTRODUCTION: The aim of this study was to assess the exposure to cardiovascular disease (CVD) risk factors in patients with juvenile idiopathic arthritis (JIA). Intima-media complex thickness (IMT), selected metabolic parameters and health behaviors were assessed in the course of the study. METHODS: The study included study group, which consisted of 45 patients with JIA and 37 healthy age- and sex-matched children in the control group. Analyses in both groups included anthropometric parameters, laboratory tests, IMT and a questionnaire on exposure to modifiable CVD risk factors. RESULTS: The study confirmed that CVD risk factors were present in both groups of patients. Significantly more children with JIA had abnormal BMI (p = 0.006) compared to the control group. Children in the study group were more likely to consume fruit regularly (p = 0.021) and less likely to consume fast food (p = 0.011) and sweetened beverages (p = 0.042) than children in the control group. Only 1 patient with JIA met criteria for ideal cardiovascular health. Dietary habits were not associated with IMT values, BMI, presence of joint pain or biochemical parameters in the study group. CONCLUSIONS: Patients with JIA are exposed to cardiovascular risk factors equally to their healthy peers. Ideal cardiovascular health should be pursued in the pediatric population with particular attention paid to patients with chronic diseases (i.e., JIA). The application of carotid artery IMT measurement in the assessment of CVD risk requires studies on a larger group of patients.

Why and How Should We Assess the Cardiovascular Risk in Patients with Juvenile Idiopathic Arthritis? A Single-Centre Experience with Carotid Intima-Media Measurements.

BACKGROUND: Children diagnosed with juvenile idiopathic arthritis (JIA) are thought to be more likely to develop cardiovascular disease in adulthood. The factors modulating the cardiovascular risk, involving exposure to secondhand smoking, sedentary lifestyle and abnormal body mass index, might have had a stronger impact during the COVID-19 pandemic. The lack of reliable prognostic markers for a higher probability of cardiovascular events might be solved by carotid intima-media thickness (cIMT) measurement. The paramount goal of the study was to assess its usefulness in JIA patients. MATERIALS AND METHODS: The results of cIMT measured by a single physician in 45 children diagnosed with JIA were compared to 37 age- and sex-matched healthy counterparts. The analysis also involved anthropometric parameters, laboratory tests, and a survey regarding lifestyle-related factors. RESULTS: Four JIA patients appeared to have cIMT above the 94th percentile. A positive correlation between erythrocytes sedimentation rate (ESR) and right carotid artery percentiles was found. Passive smoking increased the cardiovascular risk regardless of JIA. Doubling the daily screen time during the pandemic led to a significant reduction in children's physical activity. However, the number of enrolled subjects was not enough to make significant recommendations. CONCLUSIONS: cIMT measurements remain an interesting perspective for future cardiovascular screening of children with JIA. It has yet to be determined whether it should be considered in all JIA patients on a reliable basis.

Serum Adipocytokines Profile in Children Born Small and Appropriate for Gestational Age-A Comparative Study.

BACKGROUND: Adipose tissue is not only a storage place for fat, but also an endocrine organ, secreting bioactive molecules which influence body metabolism. Such molecules are known as adipocytokines. In the past years the coincidence between adipocytokines and fetal growth restriction disorders was found. The aim of the study was to estimate serum levels of adiponectin, leptin and resistin in children born small for gestational age, compared to children born at an appropriate size for gestational age. METHODS: The study consisted of 35 children aged seven to nine years, born SGA (small for gestational age) on term and 25 healthy children (14 girls, 11 boys), born with proper birthweight (AGA-appropriate for gestational age)-control group. RESULTS: Adiponectin and leptin levels were significantly higher in the SGA group compared to the AGA group (p = 0.023, p = 0.018 respectively). The resistin values were comparable in both groups of patients. There was a positive correlation between serum leptin concentration and current body weight in SGA group (r = 0.28; p = 0.108). In turn, adiponectin levels in this group of patients negatively correlated with actual body weight (r = -0.51; p = 0.002). The negative correlation between body mass index and plasma adiponectin levels was found only in children born SGA. SGA children had significantly higher values of diastolic blood pressure. There was negative correlation between serum adiponectin level and systolic blood pressure in SGA children. In the SGA group the phenomenon of catch-up growth was observed in 32 children. CONCLUSIONS: Children born SGA have abnormal adipose tissue biomarkers profiles.

Evaluation of Health-Promoting Behaviors in the Prevention of Cardiovascular Diseases in the Preschool Children of Polish Health Care Professionals.

BACKGROUND: The aim of the study was to evaluate the health-promoting behavior of the preschool children (aged 3-6 y) of Polish health care professionals (HCPs). METHODS: The study was conducted by means of quantitative research on a group of 386 individuals, using an Internet-based survey. RESULTS: The ideal cardiovascular health model was determined in the case of 22 children (5.6%). The collected data revealed that, when regarding the recommended level of physical activity, children from HCP families meet the American Heart Association criteria much more often than their peers from other study populations (56.5% vs. 16.6%). In our study, more girls than boys participated in organized activities (60.2% vs. 50.3%, p = 0.05). There was no correlation between achieving adequate levels of physical activity and the BMI (p > 0.1). Overweight children had a more balanced diet than children with a normal body weight (p = 0.009). CONCLUSIONS: The obtained results allowed us to make the conclusion that there is a need to implement educational and preventive measures on a large scale, while some health-promoting behaviors, especially those concerning proper nutrition, require major modifications, even in HCP families.

Myocardial dysfunction in children with intrauterine growth restriction: an echocardiographic study.

INTRODUCTION: The prevalence of intrauterine growth restriction (IUGR) is about 3-10% of live-born newborns and can be as high as 20% in developing countries. It may result in the occurrence of cardiovascular diseases later in life. METHODS: The aim of this study was echocardiographic evaluation, with the use of conventional and tissue Doppler parameters, of cardiac function in children born with IUGR, and comparison with healthy peers born as normally grown foetuses. RESULTS: In the IUGR group, E wave and E/A ratio were significantly lower compared to the control group. A wave, isovolumetric relaxation time, deceleration time, myocardial performance index as well as E/E' septal and E/E' lateral indices were significantly higher compared to healthy peers. CONCLUSION: Children with IUGR presented with subclinical myocardial dysfunction.

Myocardial dysfunction measured by tissue Doppler echocardiography in children with primary arterial hypertension.

BACKGROUND AND AIM: To evaluate myocardial function with the use of tissue Doppler echocardiography in children with primary hypertension. METHODS: A total of 64 subjects (34 with hypertension, 30 control) underwent echocardiographic evaluation of systolic and diastolic function with the use of standard and tissue Doppler echocardiography parameters. RESULTS: The left ventricular myocardial performance index was higher in children with hypertension (0.46 ± 0.08 vs. 0.35 ± 0.03; p < 0.01). The value of the A wave was higher in the hypertensive children group (0.59 ± 0.12 m/s vs. 0.49 ± 0.09 m/s; p < 0.01), while the E/A ratio was significantly lower in this group (1.58 ± 0.31 vs. 1.77 ± 0.28; p < 0.01). The values of isovolumetric relaxation time and deceleration time were significantly higher in patients with blood pressure elevation. The velocity of mitral flow propagation was lower (0.61 ± 0.08 m/s vs. 0.72 ± 0.10 m/s; p < 0.01) and E/Vp ratio was higher (1.50 ± 0.27 vs. 1.21 ± 0.23; p < 0.01) in hypertensive children. Evaluation of the left ventricle function with the use of tissue Doppler echocardiography showed significantly worse values of S' and E' septal, and S' and E' lateral in hypertensive children. The value of septal E'/A' ratio was lower in children with hypertension (1.52 ± 0.24 vs. 1.69 ± 0.25; p < 0.01), while the value of this index for lateral wall was similar. The values of E/E' septal and E/E' lateral were higher in patients with hypertension. CONCLUSIONS: In children with primary arterial hypertension, with the use of tissue Doppler echocardiography there are significantly lower values of diastolic and systolic parameters observed, which may be a sign of myocardial function deterioration.

Intra-uterine growth restriction as a risk factor for hypertension in children six to 10 years old.

INTRODUCTION: Intra-uterine growth restriction (IUGR) is present in about 3-10% of live-born newborns and it is as high as 20-30% in developing countries. Since the 1990s, it has been known that abnormalities during foetal growth may result in cardiovascular disease, including hypertension in adulthood. METHODS: This study evaluated blood pressure parameters (using ambulatory blood pressure monitoring) in children aged six to 10 years old, born as small for gestational age (SGA), and compared them to their healthy peers born as appropriate for gestational age (AGA). RESULTS: In the SGA group, an abnormal blood pressure level (prehypertension or hypertension) was present significantly more often than in the AGA group (50 vs 16%, p < 0.01). This relationship also occurred in association with the type of IUGR (asymmetric p < 0.01, symmetric p < 0.05). CONCLUSIONS: In SGA children, abnormal blood pressure values occurred more frequently than in AGA children.

Prenatal diagnosis and follow-up of 23 cases of cardiac tumors.

OBJECTIVE: To evaluate the prenatal characteristics and postnatal outcome of cardiac tumors diagnosed at two prenatal Polish cardiology centers. METHODS: Descriptive analysis of 23 fetuses with cardiac tumors (12 multiple and 11 single) diagnosed over 16 years (from 1993 to 2009). Congestive heart failure was diagnosed when the cardiovascular profile score was seven or less. RESULTS: Associated structural congenital heart defects were present in three fetuses, extracardiac anomalies in three, and chromosomal anomalies in two. Congestive heart failure developed in five cases. Perinatal survival was not different between cases with and without cardiac failure (2/5 vs 12/18, p = 0.28). The main ultrasonographic signs observed prenatally in association with cardiac tumors were cardiomegaly, left ventricular outflow tract obstruction, pericardial effusion, and hypokinesis. A diagnosis of tuberous sclerosis was eventually made in all 12 fetuses with multiple tumors. Perinatal death occurred in 4/11 cases with single tumors and in 5/12 with multiple tumors (p = 0.57). Surgical resection of the tumor was performed in 3/11 neonates with single tumors (histopathologically: rhabdomyoma, teratoma, and fibroma) and in 2/12 with multiple tumors (both rhabdomyomas). CONCLUSIONS: Survival is not different between neonates with single and multiple tumors and between those with and without congestive heart failure.