Early Growth and Midchildhood Blood Pressure (p 301)
In recent years, the prevalence of hypertension and prehypertension, conditions previously confined to adult populations, increased among children and adolescents. Considering that high blood pressure (BP) in early life is a strong risk factor for adult hypertension, identifying modifiable determinants of elevated BP as early as possible in the life course could translate into new preventive strategies. In a study of 957 participants of Project Viva, a US prebirth cohort, we investigated the associations of adiposity gain (change in body mass index z score) and linear growth (change in length or height z score) during 4 early-life age intervals (birth to 6 months, 6 months to 1 year, 1–2 years, and 2–3 years) with BP in midchildhood (age range, 6–10 years). We found that each additional z score gain in body mass index during birth to 6 months and 2 to 3 years corresponded with 0.81 (95% confidence interval, 0.15–1.46) and 1.61 (95% confidence interval, 0.33–2.89) mm Hg higher systolic BP, respectively. Length/height gain was unrelated to midchildhood BP, nor did any association of early growth with BP differ by birth size. Our findings suggest that faster adiposity gain during the first 6 postnatal months and in the preschool years leads to higher BP in midchildhood, regardless of size at birth. Strategies to reduce accrual of adiposity during early life may reduce midchildhood BP, with the potential to reduce risk of hypertension and cardiovascular disease in adulthood.
Renal Denervation Versus Pharmacotherapy (p 397)
Catheter-based renal denervation (RDN) has been considered as a new hope for patients with resistant hypertension and spread worldwide after the first studies were published in 2011. However, the first randomized controlled studies appeared only at the beginning of 2014 and cast some doubts on the real antihypertensive effect of RDN.
In this issue of Hypertension, Rosa et al present 12-month results of the Prague-15 study, which compared RDN to intensified pharmacological treatment. Per-protocol analysis showed that spironolactone addition might be more effective in blood pressure reduction than RDN with 1 year of treatment in truly resistant hypertension. Spironolactone should be considered as a part of the combination drug strategy in all resistant hypertensive patients. On the other hand, this study revealed a relatively high incidence of spironolactone side effects, especially related to antiandrogen actions.
These results do not support RDN using the current techniques as a general approach to treat resistant hypertension. More effective multielectrode systems and new generation catheters remain to be established, as do potential benefits in specific patient groups. Currently, RDN should be used only in specialized hypertension centers as a part of properly designed studies.
Cardiovascular Effects of Living Kidney Donation (p 368)
This 1-year prospective study of kidney donors and carefully selected fit-for- donation control subjects demonstrated that the expected decline in glomerular filtration rate after donation is associated with a range of adverse cardiovascular effects including increased left ventricular mass, reduced long axis function, reduced aortic distensibility, a rise in high-sensitivity C-reactive protein, and an increased prevalence of detectable high sensitivity troponin and microalbuminuria. These findings provide a pathophysiological basis for the recent observation that kidney donors may be at increased late risk of cardiovascular events when compared with appropriate highly selected healthy controls (although their absolute risk remains lower than the general population). They also provide some evidence that a reduced glomerular filtration rate may be an independent risk factor for cardiovascular disease in the community, and that this effect may be mediated by effects on large arteries, the left ventricle, and systemic inflammation. Early-stage chronic kidney disease affects >10% of US and UK populations, so that although these effects may confer a small increase in risk to an individual, the effects on public health could be large. It has been known for some time that patients with early-stage chronic kidney disease are at greater risk of cardiovascular disease than of progression to serious renal disease. This study provides mechanistic insights into this heightened risk and suggests that efforts to reduce cardiovascular events should be centered on reducing left ventricular disease and large artery stiffness rather and not just on preventing and treating atheroma.
- © 2016 American Heart Association, Inc.