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The Effect of Obesity, Gender and Ethnic Group of Left Ventricular Hypertrophy in Hypertensive Children: A Collaborative Study of the International Pediatric Hypertension AssociationHavevold C, Waller J, Daniels S et al. Pediatrics 2004;113:328-333
Reviewed by: Thomas J. Mancuso, MD, FAAP
The authors of this paper wanted to determine the prevalence of left ventricular hypertrophy in a group of hypertensive children and adolescents. Data from the International Pediatric Hypertension Association were reviewed. Left ventricular mass index (LVMI) was defined as LVM/height. Left ventricular hypertrophy (LVH) was determined using both pediatric (> 38.6 gm/m) and adult (>51gm/m) criteria.
There were 129 children in the study from three pediatric centers in the US. The mean age was 13.6 +/- 3.6 years. The group was 67% male, 46% white, 38% African American, 15% Hispanic. The prevalence of LHH was 15% using adult criteria and 41% using pediatric criteria. Using either pediatric or adult criteria LVH was associated with a body mass index (BMI) > 95th percentile. The authors noted that LVH was seen more frequently in African and American children than in white children. Using pediatric criteria, 70% of Hispanic children in this study had LVH. In addition, LV geometry was evaluated. In similar studies of adults, those with hypertension and concentric hypertrophy had the worse prognosis for cardiovascular disease whereas those with eccentric hypertrophy had an intermediate prognosis. Concentric hypertrophy was noted with greater frequency in hypertensive children who were Hispanic and African American in this population.
These two papers demonstrate an increasing prevalence of cardiovascular risk in children and adolescents. Overweight, hypertension are increasing and serious sequelae are rather common. As the authors of the second paper state in the final paragraph of this publication ".if current trends continue, the frequency of obesity-related hypertension and LVH can be expected to increase in the future". I am uncertain how to interpret these results and equally uncertain what changes to make in the preop evaluation and intra-op management of obese teenagers. Certainly it is prudent to any obtain pertinent records from pediatricians such as prior ECG or Echo's, BP trends, etc. It is also obviously important to have accurate measurements of BP in these children both in the preanesthetic evaluation and during the procedure itself. Proper size BP cuffs are essential. It may be that soon we, in pediatrics, will be monitoring two ECG leads as is done in the care of adults. Given the high prevalence of LVH found in this retrospective review, it is hard to argue against intra operative monitoring of the V5 lead in addition to V2 on the ECG in hypertensive, obese adolescents.
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