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(Hypertension. 1997;30:377.)
© 1997 American Heart Association, Inc.

Articles

Relations of Left Ventricular Geometry and Function to Body Composition in Children With High Casual Blood Pressure

Giovanni de Simone; Gian Francesco Mureddu; Rosanna Greco; Luca Scalfi; Antonella Esposito Del Puente; Adriana Franzese; Franco Contaldo; Richard B. Devereux

From the Nutrition Unit (G. de S., G.F.M., R.G., A.E.D.P., F.C.), Department of Clinical and Experimental Medicine, Department of Food Science (L.S.), and Department of Pediatrics (A.F.), Federico II University Hospital School of Medicine, Naples, Italy; and the Division of Cardiology (G. de S., R.B.D.), New York Hospital, Cornell Medical Center, New York.

Correspondence to Dr Giovanni de Simone, Dipartimento di Medicina Clinica e Sperimentale, Policlinico dell’Università Federico II, via S. Pansini 5, 80131 Napoli, Italia. E-mail simogi{at}unina.it

Abstract To determine whether abnormal casual blood pressure (BP) is associated with left ventricular (LV) abnormalities in children, 190 6- to 11-year-old children (77 girls, 113 boys) were studied at a school site in Naples, Italy, by limited echocardiography and bioelectric impedance to calculate fat-free body mass (FFM). Single-visit BP measurements (defined as casual BP) were high (based on the Italian tables of BP) in 34 children (18%; 9 girls, 25 boys; 133±8/81±10 mm Hg) and obesity was present in 44 (23%; 15 girls, 29 boys). Sex- and age-independent risk of high casual BP value was 2.9-fold (odds ratio) greater in obese than in normal-weight children (95% confidence interval, 1.3 to 6.5; P<.01). LV mass (as both absolute value and normalized for height^2.7 or FFM) was higher and relative wall thickness increased in children with high casual BP (all P<.01). Prevalence of LV hypertrophy was 21% among children with high casual BP (P<.004 versus 4.3% in normal group). Risk of LV hypertrophy was 5.5-fold higher in the presence of high casual BP (P<.004), whereas obesity, age, and sex did not have independent effects. Endocardial shortening was slightly higher in children with high casual BP (36.8±8.2%) than in children with normal BP (34.3±4.8%, P<.02), whereas midwall shortening was identical in the two groups (20%). Both endocardial shortening and midwall shortening were negatively related to end-systolic stress (r=-.62, SEE=3.8% and r=-.32, SEE=2.4% in normal children). Shortening as a percentage of predicted from wall stress was increased in children with high casual BP at the endocardial level (P<.001), whereas it was normal at the midwall. Therefore, (1) casual detection of high BP in school children is associated with LV geometric abnormalities similar to those found in adults with sustained hypertension (LV hypertrophy, concentric pattern); (2) similar to in adult hypertension, endocardial chamber function in children is supranormal; and (3) in contrast to findings in adults, midwall shortening is normal in children with high casual BP.

Key Words: children • echocardiography • obesity • hypertrophy • ventricular function, left • body composition

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