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(Hypertension. 2008;51:1289.)
© 2008 American Heart Association, Inc.

Original Articles

Analysis of Heart Period and Arterial Pressure Variability in Childhood Hypertension

Key Role of Baroreflex Impairment

Simonetta Genovesi; Federico Pieruzzi; Marco Giussani; Valentina Tono; Andrea Stella; Alberto Porta; Massimo Pagani; Daniela Lucini

From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences "L. Sacco" (M.P., D.L.), University of Milano, Milan, Italy.

Correspondence to Daniela Lucini, Centro Terapia Neurovegetativa, Università di Milano, Ospedale "L. Sacco" Via G.B. Grassi, 74, 20157 Milan, Italy. E-mail daniela.lucini{at}ctnv.unimi.it

In adults, initial stages of hypertension are associated with elevated sympathetic drive and significant alterations in indirect autonomic markers. There is growing evidence that children in the highest-pressure percentiles will be more likely to develop hypertension in adulthood, although mechanisms are not understood. We assessed whether computer analysis of RR interval and arterial blood pressure variability could detect early autonomic alterations in childhood hypertension, as assessed by noninvasive time and frequency domain measures of baroreflex regulation. We studied 75 children, subdivided in 3 subgroups of similar age (9.7±0.2 years): control subjects, prehypertensive children (ie, children with arterial pressure values >90th and <95th percentile for age, gender, and height), and children in the hypertensive range (ie, >95th percentile; systolic arterial pressure: 97±3/57±2, 121±5/70±1, and 128±2/80±2 mm Hg, respectively). We observed that hypertensive children demonstrate a significant impairment of the baroreflex as compared with control subjects (index : 20±2 and 40±4 ms/mm Hg; spontaneous baroreflex slope: 20±2 and 37±5; ms/mm Hg; P<0.05 in both cases) and reduced RR variance. A similar baroreflex impairment is also observed in children whose arterial pressure falls short of this limit, ie, in the prehypertensive range. In conclusion, hypertensive children display a marked baroreflex impairment. A similar baroreflex impairment is also observed in the prehypertensive state. Baroreflex assessment could furnish additional information in the clinical assessment of pediatric hypertension.

Key Words: hypertension • pediatrics • baroreceptors • autonomic nervous system • lifestyle

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