Aug 2026· Pediatric nephrology (Berlin, West)· 0 citations· 27 references
Medicine
TL;DR
M Masked and particularly isolated nocturnal hypertension were highly prevalent, underscoring the importance of ABPM in this population, and PWV abnormalities were observed in children with ambulatory hypertension, suggesting that PWV changes are more closely related to blood pressure abnormalities than to the diagnosis of T1DM itself.
Renal artery variations are recognized as potential contributors to hypertension through altered renal perfusion and activation of renin–angiotensin system. However, their clinical and hemodynamic significance in children remains unclear. This retrospective study included 14 pediatric patients (0–18 years) with hypertension and renal artery variations. Demographic, laboratory, echocardiographic and ambulatory blood pressure monitoring (ABPM) data were analyzed at baseline and follow‐up. Patients were stratified according to serum renin levels (elevated vs. normal). Accessory renal arteries and early branching were identified in 78.4% and 42.8% of patients, respectively. At baseline, 38.4% of patients had left ventricular hypertrophy and most exhibited nocturnal hypertension with impaired dipping patterns. Although daytime, nighttime blood pressure (BP) SDS values tended to decrease during follow‐up; 24‐h, daytime, nighttime systolic, diastolic BP and mean arterial pressure values did not change significantly in either group. Patients with elevated renin levels showed persistently higher nocturnal BP‐SDS values and more pronounced non‐dipping patterns. In the high‐renin group, left ventricle relative wall thickness (RWT) decreased significantly from 0.41(0.36–0.43)–0.31(0.27–0.35) (p = 0.03), whereas left ventricular mass index (LVMI) remained unchanged [33(30–40] vs. 37(34–45) g/m2·7, p = 0.56]. In the normal‐renin group, LVMI showed nonsignificant tendency to decrease [34(32–55) vs. 30(29–51) g/m2·7, p = 0.06], while the reduction in RWT did not reach statistical significance (p = 0.12). Renal artery variations in children should not be considered purely anatomical findings. Persistent nocturnal hypertension and impaired dipping patterns, particularly in patients with elevated renin levels, may contribute to ongoing target organ damage. Although ABPM parameters remained largely unchanged during follow‐up, cardiac remodeling showed distinct patterns according to renin status.
M. B. Aytaç, Kenan Doğan, N. Malkoc et al.· The Journal of Clinical Hype...· 0 citations
BACKGROUND
There is limited data on the associations of (glycated hemoglobin A1C [HbA1C], fasting plasma glucose, and 2-hour postload glucose) and insulin resistance (fasting plasma insulin, insulin-to-glucose ratio, homeostasis model assessment of insulin resistance, and quantitative insulin sensitivity check index) markers with arterial stiffness.
METHODS
We included 6617 Framingham Heart Study participants (53.8% women; 6.9% diabetes, mean age: 48±14 years). Arterial stiffness measures included natural log (Ln)-transformed carotid-femoral pulse wave velocity, augmentation index (AIx), central pulse pressure, carotid-brachial pulse wave velocity, carotid-radial pulse wave velocity, and brachial pulse pressure. Estimates of associations were adjusted for several clinical characteristics.
RESULTS
Adjusted means of log (Ln)-transformed carotid-femoral pulse wave velocity, AIx, and carotid-brachial pulse wave velocity were increasingly abnormal with higher HbA1C (all P<0.05). Each 1% higher HbA1C was associated with elevated CFPWV (odds ratio [OR], 1.24 [95% CI, 1.11-1.39]) and lower AIx (OR, 0.86 [95% CI, 0.78-0.95]). Each 10-mg/dL higher fasting plasma glucose was associated with elevated CFPWV (OR, 1.09 [95% CI, 1.05-1.13]), but lower AIx (OR, 0.91 [95% CI, 0.87-0.94]). Each 10-mg/dL higher 2-hour postload glucose was associated with elevated CFPWV (OR, 1.04 [95% CI, 1.01-1.07]), central pulse pressure (OR, 1.04 [95% CI, 1.02-1.06]), brachial pulse pressure (OR, 1.04 [95% CI, 1.02-1.06]), but lower AIx (OR, 0.94 [95% CI, 0.91-0.96]). Higher fasting plasma insulin, insulin-to-glucose ratio, homeostasis model assessment of insulin resistance, and lower quantitative insulin sensitivity check index were associated with higher CFPWV and lower AIx (all P<0.05).
CONCLUSIONS
In community-dwelling individuals, worse glycemia and insulin sensitivity were associated with abnormal arterial stiffness.
S. Noumegni, Stephen P. Juraschek, Jordana B. Cohen et al.· HYPERTENSION· 0 citations
Background and Objectives: Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor associated with atherosclerosis, vascular inflammation, and endothelial dysfunction. However, data regarding its relationship with hypertension-mediated organ damage and circadian blood pressure abnormalities remain limited. We aimed to investigate the association of elevated Lp(a) levels with carotid atherosclerosis and nocturnal blood pressure dipping patterns in patients with hypertension. Materials and Methods: This retrospective cross-sectional study included 80 nondiabetic patients with essential hypertension. Patients were categorized according to serum Lp(a) levels into elevated Lp(a) (≥50 mg/dL, n = 20) and lower Lp(a) (<50 mg/dL, n = 60) groups. All participants underwent carotid ultrasonography, transthoracic echocardiography, ambulatory blood pressure monitoring, and ophthalmologic evaluation. Multivariable logistic and linear regression analyses were performed to determine independent associations between Lp(a), carotid plaque presence, and nocturnal dipping percentage. Results: Patients with elevated Lp(a) levels had a significantly higher prevalence of carotid plaque (55.0% vs. 23.3%, p = 0.008) and non-dipper hypertension (75.0% vs. 46.7%, p = 0.028) compared with patients with lower Lp(a) levels. Serum Lp(a) concentrations were inversely correlated with nocturnal dipping percentage (r = −0.362, p = 0.001). In multivariable logistic regression analysis adjusted for age, sex, LDL cholesterol, and active smoking, elevated Lp(a) remained independently associated with carotid plaque presence (OR 3.24, 95% CI 1.06–9.80, p = 0.039). In multiple linear regression analysis adjusted for age, sex, LDL cholesterol, and office systolic blood pressure, higher Lp(a) levels remained independently associated with lower nocturnal dipping percentage (β = −0.294, p = 0.008). No significant associations were observed between Lp(a) and carotid intima–media thickness, left ventricular hypertrophy, hypertensive retinopathy, or renal functional parameters. Conclusions: Elevated Lp(a) levels were independently associated with carotid plaque presence and impaired nocturnal blood pressure decline in hypertensive patients. These findings suggest that Lp(a) may be more closely linked to focal macrovascular atherosclerosis and abnormal circadian blood pressure regulation rather than diffuse hypertensive structural remodeling.
T. Kunak, Ayşegül Ülgen Kunak, I. Basarici· Medicina· 0 citations
Background
Obesity, hyperlipidemia, intensive immunosuppressive use, and hypertension have detrimental effects on vascular structure and function after renal replacement therapy. Pulse wave velocity (PWV) is the gold standard for evaluating arterial stiffness. We aimed to determine cardiovascular target organ damage in adolescent kidney transplant patients using noninvasive PWV measurements and to investigate the risk factors that influence it.
Methods
T his study included 4 5 adolescent patients who had u ndergone renal replacement therapy between 1994 and 2020 at Ege University Children's Hospital. Cardiovascular evaluation included PWV and augmentation index (AIx@75) measurements, expressed as Z-scores adjusted for sex and height. Biochemical, demographic, and clinical data were compared with height-adjusted PWV Z-scores (PWV Z-height) and AIx@75.
Results
Twenty-four male and 21 female patients underwent transplantation at a mean age of 7.69±4.77 years. Systolic blood pressure (BP) Z-scores correlated significantly with PWV Z-height (ρ=0.56, P=0.001) and AIx@75 (ρ=0.29, P=0.049). Weak positive correlations were detected between PWV Z-height and triglyceride levels (ρ=0.45, P=0.02), mean arterial pressure (ρ=0.44, P=0.02), and C-reactive protein (ρ=0.42, P=0.04). Patients with higher AIx@75 (≥30) had significantly higher systolic BP Z-scores and PWV Z-height scores. Arterial stiffness indices did not differ by pretransplant dialysis modality. On multivariable linear regression, systolic BP Z-score was the only independent predictor of PWV Z-height (β=0.854, P<0.001).
Conclusions
Posttransplant treatment of hypertension and hyperlipidemia is important to reduce cardiovascular burden in pediatric kidney transplant patients, highlighting the need for close monitoring and management of BP and lipid levels.
S. Tunçay, Merve Ceren Yaşlı, Zeynep Sude Yıldırım et al.· Clinical transplantation and...· 0 citations
BACKGROUND
In clinical practice, blood pressure (BP) is typically assessed using brachial measurements, whereas finger plethysmography is widely used in vascular physiology research. However, agreement between BP levels at the finger and more proximal sites is not straightforward because of interindividual differences in BP gradients along the arterial tree.
METHODS
We investigated factors associated with the mean arterial pressure (MAP) difference between non-invasive radial artery and finger measurements in 574 normotensive and hypertensive individuals without cardiovascular disease, diabetes, or antihypertensive medication. Recordings included pulse wave analysis from radial BP, plethysmographic finger BP, and whole-body impedance cardiography. Radial BP signals were calibrated using oscillometric contralateral brachial artery measurements.
RESULTS
Simultaneous mean radial and finger BP (systolic/diastolic) were 131/75 and 122/69 mmHg, respectively (p < 0.001). When examined in quartiles of the radial-finger BP gradient, the average MAP difference was -7, 4, 10, and 20 mmHg, respectively. In linear regression analysis (enter method), a greater MAP difference was significantly associated with higher radial MAP (p < 0.001), age (p = 0.001), and stroke index (p = 0.015); and with lower pulse wave velocity (p < 0.001), pulse pressure amplification (p = 0.002), and insulin sensitivity check index (p = 0.022).
CONCLUSIONS
High mean arterial pressure is a major factor contributing to greater blood pressure difference between the radial and finger sites. However, the difference is also more pronounced in the presence of lower large artery stiffness, lower pulse pressure amplification, and higher stroke index, older age, and greater insulin resistance.
M. Choudhary, Tuomas P. Saarinen, Matti Oivo et al.· Blood Pressure· 0 citations
BACKGROUND
To quantify the association between ambulatory arterial stiffness index (AASI) and hypertensive status, and to identify additional predictors of AASI, including body mass index (BMI), proteinuria, and mineral metabolism, in children and adolescents with chronic kidney disease (CKD).
METHODS
We analyzed data collected from 654 participants during 1283 study visits in the Chronic Kidney Disease in Children (CKiD) prospective cohort study. AASI was calculated from ambulatory blood pressure monitoring (ABPM) data as 1 minus the slope coefficient from a least squares linear regression of diastolic blood pressure (BP) on systolic BP. Hypertensive status was determined by clinic BP and ABPM. Linear regression with generalized estimating equations to account for repeated AASI measurements over time within the same participant were used to quantify the relationship between AASI and hypertensive status.
RESULTS
At their first successful ABPM visit, the median age was 12 years, 61% were male, 15% had obesity and the median eGFR was 49 ml/min/1.73 m2. Over half (57%) reported current antihypertensive therapy use with RAAS inhibitors, yet 42% met criteria for abnormal ABPM (elevated mean total/awake/sleep DBP/SBP per updated guidelines). Masked hypertension (MH) was common (27%) and associated with significantly higher AASI compared to being normotensive (difference in mean AASI: + 0.051, 95% CI: 0.032, 0.071). Male sex and higher BMI were associated with higher AASI, but the presence of proteinuria, abnormal serum calcium or phosphate were not.
CONCLUSION
AASI is associated with MH and BMI in children and adolescents with CKD and may be a useful non-invasive measure of vascular stiffness in this population.
S. Halbach, Jennifer L. Roem, Michael F. Schneider et al.· Pediatric nephrology (Berlin...· 0 citations
