Hypertension in Children and Adolescents: New Perspectives PDF
Preview Hypertension in Children and Adolescents: New Perspectives
Updates in Hypertension and Cardiovascular Protection Series Editors: Giuseppe Mancia · Enrico Agabiti Rosei Empar Lurbe Elke Wühl Editors Hypertension in Children and Adolescents New Perspectives Updates in Hypertension and Cardiovascular Protection Series Editors Giuseppe Mancia Milano, Italy Enrico Agabiti Rosei Brescia, Italy The aim of this series is to provide informative updates on both the knowledge and the clinical management of a disease that, if uncontrolled, can very seriously damage the human body and is still among the leading causes of death worldwide. Although hypertension is associated mainly with cardiovascular, endocrine, and renal disorders, it is highly relevant to a wide range of medical specialties and fields – from family medicine to physiology, genetics, and pharmacology. The topics addressed by volumes in the series Updates in Hypertension and Cardiovascular Protection have been selected for their broad significance and will be of interest to all who are involved with this disease, whether residents, fellows, practitioners, or researchers. More information about this series at http://www.springer.com/series/15049 Empar Lurbe • Elke Wühl Editors Hypertension in Children and Adolescents New Perspectives Editors Empar Lurbe Elke Wühl Head of Pediatrics Department Center for Pediatric and Adolescent Hospital General Universitario Valencia Medicine Valencia University Hospital Heidelberg Spain Heidelberg Germany ISSN 2366-4606 ISSN 2366-4614 (electronic) Updates in Hypertension and Cardiovascular Protection ISBN 978-3-030-18166-6 ISBN 978-3-030-18167-3 (eBook) https://doi.org/10.1007/978-3-030-18167-3 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica- tion does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword It is a pleasure to introduce the book on Hypertension in Children and Adolescents, edited by Professors Empar Lurbe and Elke Wühl, to which many worldwide known experts have contributed. The book belongs to the series of Hypertension Books coordinated by Professor Agabiti-Rosei and myself on behalf of the European Society of Hypertension. The importance of a book on hypertension in children and adolescents can hardly be overemphasized. Until not so long ago, finding a blood pressure (BP) elevation in individuals aged less than 18 years was regarded as a very rare event largely, if not exclusively, due to secondary causes, whose identification thus rep- resented the main, if not the only, diagnostic goal. Since then, clinical evidence has progressed considerably and it is now known that (1) although its prevalence is lower than in older patients, hypertension in children and adolescents is not at all uncommon and (2) its origin is by no means limited to renal, endocrine, or other diseases but extends to primary hypertension which in adolescents and children has a prevalence that makes regular BP measurements as mandatory as in adults. Knowledge has also considerably increased on the appropriate diagnostic and ther- apeutic strategies to adopt in the variable phenotypes with which childhood and adolescence hypertension becomes manifest, including those related to the differ- ent levels of office and out-of-office BP values as well as to their selective eleva- tion. This has made publication of evidence-based comprehensive clinical guidelines for childhood and adolescence hypertension not only possible but also as necessary as for adult hypertension. Clinical progress has been paralleled by progress on the pathophysiological aspects of childhood and adolescence hypertension that has made this area of research very productive. Evidence has been obtained on the multifold structural and functional abnormalities of the cardiovascular system that can be seen in young hypertensive individuals. The genetic component of hypertension of the young has been and is being addressed by many studies, and it is now known in greater detail with regard not only to the monogenic forms of hypertension but also to the genetic component of primary hypertension. Research has also clarified to an in-depth degree both the BP patterns and the other factors that are more likely to be associ- ated with, and thus predict, future BP elevations, incident hypertension, and level of cardiovascular risk in adults. Finally, evidence has been obtained that many altera- tions of cardiovascular control mechanisms shown in adult hypertension can be v vi Foreword traced back, to a smaller but still clear degree, to young individuals who are either in an early hypertension phase or have a normal BP but a hypertension familiarity, with thus a greater risk of developing hypertension during their life. This represents an important opportunity to improve knowledge of the factors individually or inter- actively involved in the genesis of hypertension. Indeed, this area of research is nowadays not limited to adolescence and childhood but it extends to newborn and fetal alterations, which have been shown in several cases to also have a predictive value for adulthood abnormalities. All this is addressed in the Lurbe and Wühl book, which thus provides an over- view of the matter not easily available elsewhere. The initial chapters deal with the prevalence, trends, and BP trajectories of hypertension in the young age, including those detectable by out-of-office and central BP measurements. Other chapters dis- cuss in detail the structural and functional alterations that may more commonly occur in hypertension of children and adolescents (above all those of the large and small vessels, the kidney, and the heart). Further contributions are then devoted to the specific diagnostic and therapeutic criteria and steps to adopt during BP eleva- tions in the young age, with an analysis of the specific problems posed by the clini- cal management of childhood and adolescence hypertension such as (1) the measures to be taken to detect secondary hypertensions, (2) the need to establish when a BP elevation is permanent or just transient, and (3) the difficulty to decide whether the BP elevation is likely to be clinically innocent (and treatment should be limited to nonpharmacological measures) or drug administration should also be implemented, with all the problems this step may generate at a young age. In this context, the book represents not only an updated advice to medical practice but also a source of criti- cal information on issues of great potential interest on which, however, unequivocal conclusions cannot be reached, for example, the long-term prognostic significance of isolated systolic hypertension of the young (especially if associated with central BP normality) as well as the BP, body weight, and other abnormalities seen in the newborn, the clinical impact of central vs. peripheral BP alterations, and the relative importance and timing of the disclosed abnormalities of the different BP control systems. As discussed in the book, uncertainty on these issues is largely due to a peculiar research difficulty of this area of medicine. Namely, that longitudinal stud- ies on the prognostic aspects of the documented alterations can hardly count on a statistically appropriate number of cardiovascular events, which in children and adolescents are few and occasional. An unmet need to fill is thus to identify and vali- date surrogate markers of prognosis that may reliably detect the clinical long-term consequences of the documented BP and cardiovascular alterations, as well as of the effects of the prescribed treatment, in agreement with hard events. Giuseppe Mancia University of Milano-Bicocca Milano, Italy Contents 1 From Pregnancy to Childhood and Adulthood: The Trajectory of Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Manish D. Sinha 2 The Contributions of Perinatal Programming to Blood Pressure Levels in Childhood and Beyond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Julie R. Ingelfinger 3 Worldwide Prevalence of Childhood Hypertension . . . . . . . . . . . . . . . . 31 Bonita Falkner 4 Office and Out of Office Blood Pressure Measurements . . . . . . . . . . . . 41 Stella Stabouli 5 Large Vessels in Hypertension: Central Blood Pressure . . . . . . . . . . . . 65 Stéphane Laurent and Pedro Guimarães Cunha 6 Isolated Systolic Hypertension in the Young . . . . . . . . . . . . . . . . . . . . . 85 Empar Lurbe 7 Primary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Janusz Feber and Mieczysław Litwin 8 Causes of Secondary Hypertension in Children and Adolescents . . . . 111 Rowena Lalji and Kjell Tullus 9 Monogenic Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Mieczysław Litwin, Janusz Feber, and Elżbieta Ciara 10 Neonatal Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Joseph T. Flynn 11 The Heart in Childhood Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Asle Hirth 12 The Kidney in Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Elke Wühl and Franz Schaefer vii viii Contents 13 Non-pharmacological Treatment of Hypertension . . . . . . . . . . . . . . . . 211 Dénes Páll and Miklós Zrínyi 14 Physical Exercise in the Treatment of Obesity and Hypertension: New Approach to Individualize Treatment . . . . . . . . . . . . . . . . . . . . . . . 225 Pau Redon 15 Treatment of Hypertension in Chronic Kidney Disease . . . . . . . . . . . . 239 Elke Wühl and Franz Schaefer 16 Long Term Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Tomáš Seeman 17 Evidences from Clinical Trials and Use of Antihypertensive Drugs in Children and Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 Josep Redon and Pau Redon From Pregnancy to Childhood 1 and Adulthood: The Trajectory of Hypertension Manish D. Sinha 1.1 Undernutrition and Cardiovascular Disease There is no doubt that events occurring before birth and during infancy influence risks of developing cardiovascular disease in the future. Over three decades ago, following the seminal observations by Barker and colleagues, it was first suggested that foetal events may influence risk of adult cardiovascular disease [1–3]. Barker’s observations highlighted that adverse events that impair foetal development can result in “foetal programming” of adult diseases including those affecting the car- diovascular, renal, respiratory and metabolic system [4, 5]. Several studies in differ- ent populations have confirmed the association of low birth weight (LBW) or reduced foetal growth with coronary heart disease (CHD), stroke and cardiovascular disease [6]. The concept of “programming” has been described as a process whereby a stimulus or insult at a critical period of development has lasting or lifelong signifi- cance [7]. The Barker hypothesis and the resultant foetal programming concept were expanded to the Developmental origins of health and disease (DOHaD) approach to recognise the broader scope of the “developmental cues from concep- tion to the infant and beyond and the concept that the early life environment has widespread consequences for later health” [8–10]. Following Barker’s early observations of small size at birth and cardiovascular morbidity and mortality in a “famine cohort” in Hertfordshire, UK, similar observa- tions were made by the Dutch famine study investigators who reported adverse cardiovascular outcomes in populations who had a period of poor nutrition during their early development [11–13]. These investigators highlighted differing M. D. Sinha (*) Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys & St Thomas’ NHS Foundation Trust, London, UK Kings College London, London, UK e-mail: [email protected] © Springer Nature Switzerland AG 2019 1 E. Lurbe, E. Wühl (eds.), Hypertension in Children and Adolescents, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-030-18167-3_1
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