Arterial hypertension in children and adolescents in Qatar. Precision in diagnosis is a necessity.

qatar

This is an excerpt of a scientific paper of my authorship I sent to Qatar Medical Journal for publication. References are not shown as the paper is on the approval process.

Where does Qatar stand approaching the issue of hypertension in children and adolescents?

The 2010 Global Burden of Disease Study’s profile of health status in Qatar found that non-communicable diseases, where HTN is included, are a significant cause of health issues in Qatar.

According to the revised literature the prevalence of HTN in children and adolescents in Qatar ranges from 10.5 % and can reach up to 45 % when accompanied by obesity  In the same geographic area, a large Iran-based CASPIAN-5 study has reported similar a prevalence of HTN of 11,5 %. Other countries in the Middle East do not differ on the average from these statistics.

Furthermore, a recent systematic review with meta-analysis pooling BP data from 122,053 adolescents in 55 studies, stated a prevalence of HTN of 11.2%.

All the studies carried out on children and adolescents stress the negative impact of the classic cardiovascular risk factors usually accompanying HTN as obesity, overweight and metabolic syndrome, a condition with a rapid growth and life-threatening consequences on the long term in the region

The aforementioned do not come as a surprise in Qatar since with the discovery of oil in the 70s there has been a substantial social and economic improvement in the country which has had pros and sadly cons as well. The economic rise-related downside has been principally reflected on the life style of children and adolescence which have experienced a large transition in regard with their eating habits, which are now very similar to Western countries where fast food has gained many followers among those in these groups of ages.

Hence, the incidence of cardiovascular risk factors in on the rise, where overweight, obesity and diabetes mellitus, among others, are quite prevalent with their well know deleterious consequences throughout life. In addition, scarce knowledge about food choices, lack of physical activity and common socialization-related eating , in our opinion, are playing a key role in perpetuating the prevalence of HTN at early stages of life (childhood and adolescence) in the country as well.

If this paper is published, we will post the complete publication on this blog.

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Note. This editorial has been written by Dr. Guillermo Alberto Perez Fernandez, author of this blog, and reflects his personal opinion about the topic.

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Left Ventricular Hypertrophy in Pediatric Hypertension. When damage is at sight. 

img_2190-2This is an excerpt of a publication of mine sent to a peer review journal by me to be published.

Since the publication in 1977 of the First American Task Force for the diagnosis, evaluation and treatment of high blood pressure (BP) in children and adolescents, updated in 1987, 1996 and more comprehensibly in 2004 (as Fourth Report) has been stressed out the importance of HTN related organ damage being, in this context, LVH a paradigm. Likewise, the latest European Society of HTN guidelines for the management of HTN in children and adolescents published in 2016 has highlighted the assessment of subclinical organ damage as an intermediate stage in the continuum of vascular disease as well, targeting predominantly LVH (2) Woroniecki and colleagues’ article (1) exposed the somehow puzzling issue when it comes to defining LVH in pediatric population on the basis of the existence of diverse criteria with pros and cons. These arguments are not new and have made very difficult over years to ascertain a reliable standardization of LVH definition at the early stages of life in children and adolescents suffering from HTN. Although, the authors of the article do not mention the connection of prehypertension with LVH, this association exists (3) and can trouble even more the things to decipher a definition of LVH for prehypertensive patients since the long-established studies that have reported the different formulas to define LVH in children and adolescents have been conducted on hypertensive individuals (2)

Unquestionably, the search for a definition of LVH in the context we are commenting here is complex with multiple answer and a solution far to be beheld to date; even though, the future might unfold some results especially with the American Heart Association’s SHIP-AHOY study, intended to evaluate blood pressure thresholds, ambulatory blood pressure, and metabolic phenotype that predicts hypertensive target organ damage. In addition, it is planned an update of the Fourth Report that would help with the necessary consensus on LVH (3)

In the meantime, according to our opinion, the appraisal of HTN induced LVH must get ahead of the simple quantification of left ventricular mass by focusing on the early diastolic alterations as regional mitral Ea, Aa and the E/Ea ratio by Tissue doppler imaging that precede the onset of LVH since this hypertrophy can be observed with the use of steroid, obesity, athletes, growth hormone use, etc., therefore can be reversible (4)

Those topics are not mentioned in Woroniecki and colleagues’ article (1) and might be key to increase consistency to the assessment of the HTN related cardiac organ damage in children and adolescents.

In the PESESCAD-HTA study we found diastolic abnormalities even in prehypertensive adolescents without LVH which makes it clear the relevance of targeting diastolic alterations on individuals prone to be hypertensive likely in the short term (5)

In short, the issue of LVH in pediatric populations remains challenging. The solution will lie on in undertaking large multinational studies in an attempt to find out a more reliable and matching approach to determine the cardiac organ damage that HTN entails in children and adolescents.

References

1- Woroniecki, Robert P, Andrew Kahnauth, Laurie E Panesar, and Katarina Supe-Markovina Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review. Front. Pediatr (2017) 5:101.doi:10.3389/fped.2017.00101

2- Lurbe E, Agabiti-Rosei E, Cruickshank J, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Am Soc Hypert (2016); vol: 34 (10) pp: 1887-1920.

3- Sethna CB, Leisman DE. Left Ventricular Hypertrophy in Children with Hypertension: in Search of a Definition. Curr Hypertens Rep (2016) Aug;18(8):65. doi: 10.1007/s11906-016-0672-3.

4- Agu NC, McNiece Redwine K, Bell C, Garcia KM, Martin DS, Poffenbarger TS, et al. Detection of early diastolic alterations by tissue Doppler imaging in untreated childhood-onset essential hypertension. J Am Soc Hypertens (2014);8(5):303–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24685005.

5- Perez Fernandez GA, Grau Avalo R. Hypertensive heart disease in adolescence. preliminary results of the PESESCAD-HTA study. Hipertens y Riesgo Vasc (2012) ;29(3):75–85.

Thanks.

Note. This editorial has been written by Dr. Guillermo Alberto Perez Fernandez, author of this blog, and reflects his personal opinion about the topic.

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