Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology
Published in: Pediatric Radiology 6/2019

Open Access 01-05-2019 | Magnetic Resonance Imaging | Original Article

The cardiovascular phenotype of childhood hypertension: a cardiac magnetic resonance study

Authors: Mun H. Cheang, Gregorz T. Kowalik, Michael A. Quail, Jennifer A. Steeden, Daljit Hothi, Kjell Tullus, Vivek Muthurangu

Published in: Pediatric Radiology | Issue 6/2019

Login to get access

Abstract

Background

The cardiovascular phenotype is poorly characterized in treated pediatric hypertension. Cardiovascular magnetic resonance imaging (MRI) can be used to better characterize both cardiac and vascular phenotype in children with hypertension.

Objective

To use MRI to determine the cardiac and vascular phenotypes of different forms of treated hypertension and compare the results with those of healthy children.

Materials and methods

Sixty children (15 with chronic renal disease with hypertension, 15 with renovascular hypertension, 15 with essential hypertension and 15 healthy subjects) underwent MRI with noninvasive blood pressure measurements. Cardiovascular parameters measured include systemic vascular resistance, total arterial compliance, left ventricular mass and volumetric data, ejection fraction and myocardial velocity. Between-group comparisons were used to investigate differences in the hypertension types.

Results

Renal hypertension was associated with elevated vascular resistance (P≤0.007) and normal arterial compliance. Conversely, children with essential hypertension had normal resistance but increased compliance (P=0.001). Renovascular hypertension was associated with both increased resistance and compliance (P≤0.03). There was no difference in ventricular volumes, mass or cardiac output between groups. Children with renal hypertension also had lower systolic and diastolic myocardial velocities.

Conclusion

Cardiovascular MRI may identify distinct vascular and cardiac phenotypes in different forms of treated childhood hypertension. Future studies are needed to investigate how this may inform further optimisation of blood pressure treatment in different types of hypertension.
Appendix
Available only for authorised users
Literature
1.
Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298:874–879CrossRefPubMed
2.
Sharma AK, Metzger DL, Rodd CJ (2018) Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics guidelines. JAMA Pediatr 172:557–565CrossRefPubMedPubMedCentral
3.
Gupta-Malhotra M, Banker A, Shete S et al (2015) Essential hypertension vs. secondary hypertension among children. Am J Hypertens 28:73–80CrossRefPubMed
4.
5.
Cheang MH, Barber NJ, Khushnood A et al (2018) A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 20:24CrossRefPubMedPubMedCentral
6.
Pennell DJ, Sechtem UP, Higgins CB et al (2004) Clinical indications for cardiovascular magnetic resonance (CMR): consensus panel report. J Cardiovasc Magn Reson 6:727–765CrossRefPubMed
7.
Kowalik GT, Knight DS, Steeden JA et al (2015) Assessment of cardiac time intervals using high temporal resolution real-time spiral phase contrast with UNFOLDed-SENSE. Magn Reson Med 73:749–756CrossRefPubMed
8.
Steeden JA, Knight DS, Bali S et al (2014) Self-navigated tissue phase mapping using a golden-angle spiral acquisition-proof of concept in patients with pulmonary hypertension. Magn Reson Med 71:145–155CrossRefPubMed
9.
Tullus K, Brennan E, Hamilton G et al (2008) Renovascular hypertension in children. Lancet 371:1453–1463CrossRefPubMed
10.
McCrindle BW (2010) Assessment and management of hypertension in children and adolescents. Nat Rev Cardiol 7:155–163CrossRefPubMed
11.
Odille F, Steeden JA, Muthurangu V, Atkinson D (2011) Automatic segmentation propagation of the aorta in real-time phase contrast MRI using nonrigid registration. J Magn Reson Imaging 33:232–238CrossRefPubMed
12.
Muthurangu V, Lurz P, Critchely JD et al (2008) Real-time assessment of right and left ventricular volumes and function in patients with congenital heart disease by using high spatiotemporal resolution radial k-t SENSE. Radiology 248:782–791CrossRefPubMed
13.
de Simone G, Devereux RB, Daniels SR et al (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062CrossRefPubMed
14.
Steeden JA, Atkinson D, Hansen MS et al (2011) Rapid flow assessment of congenital heart disease with high-spatiotemporal-resolution gated spiral phase-contrast MR imaging. Radiology 260:79–87CrossRefPubMedPubMedCentral
15.
Steeden JA, Atkinson D, Taylor AM, Muthurangu V (2010) Assessing vascular response to exercise using a combination of real-time spiral phase contrast MR and noninvasive blood pressure measurements. J Magn Reson Imaging 31:997–1003CrossRefPubMed
16.
Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605CrossRefPubMed
17.
Yano Y, Stamler J, Garside DB et al (2015) Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago heart association detection project in industry study. J Am Coll Cardiol 65:327–335CrossRefPubMedPubMedCentral
18.
Smulyan H, Mookherjee S, Safar ME (2016) The two faces of hypertension: role of aortic stiffness. J Am Soc Hypertens 10:175–183CrossRefPubMed
19.
Domanski MJ, Davis BR, Pfeffer MA et al (1999) Isolated systolic hypertension: prognostic information provided by pulse pressure. Hypertension 34:375–380CrossRefPubMed
20.
Mitsnefes MM, Knilans T, Mays W et al (2005) Blood pressure and total peripheral resistance in children with chronic kidney disease. Pediatr Nephrol 20:803–806CrossRefPubMed
21.
Van Biesen W, Verbeke F, Devolder I, Vanholder R (2008) The relation between salt, volume, and hypertension: clinical evidence for forgotten but still valid basic physiology. Perit Dial Int 28:596–600PubMed
22.
Grassi G, Quarti-Trevano F, Seravalle G et al (2011) Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension 57:846–851CrossRefPubMed
23.
Vaziri ND (2001) Effect of chronic renal failure on nitric oxide metabolism. Am J Kidney Dis 38:S74–S79CrossRefPubMed
24.
Li S, Chen W, Srinivasan SR, Berenson GS (2004) Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa heart study. Hypertension 43:541–546CrossRefPubMed
25.
Urbina EM, Khoury PR, McCoy C et al (2011) Cardiac and vascular consequences of pre-hypertension in youth. J Clin Hypertens (Greenwich) 13:332–342CrossRef
26.
Donald AE, Charakida M, Falaschetti E et al (2010) Determinants of vascular phenotype in a large childhood population: the Avon Longitudinal Study of Parents and Children (ALSPAC). Eur Heart J 31:1502–1510CrossRefPubMedPubMedCentral
27.
Parikh SA, Shishehbor MH, Gray BH et al (2014) SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv 84:1163–1171CrossRefPubMed
28.
Martinez-Maldonado M (1991) Pathophysiology of renovascular hypertension. Hypertension 17:707–719CrossRefPubMed
29.
Borlaug BA, Melenovsky V, Redfield MM et al (2007) Impact of arterial load and loading sequence on left ventricular tissue velocities in humans. J Am Coll Cardiol 50:1570–1577CrossRefPubMed
30.
Simpson JM, Rawlins D, Mathur S et al (2013) Systolic and diastolic ventricular function assessed by tissue Doppler imaging in children with chronic kidney disease. Echocardiography 30:331–337CrossRefPubMed
31.
Aoki K, Sato K (1986) Decrease in blood pressure and increase in total peripheral vascular resistance in supine resting subjects with normotension or essential hypertension. Jpn Heart J 27:467–474CrossRefPubMed
Metadata
Title
The cardiovascular phenotype of childhood hypertension: a cardiac magnetic resonance study
Authors
Mun H. Cheang
Gregorz T. Kowalik
Michael A. Quail
Jennifer A. Steeden
Daljit Hothi
Kjell Tullus
Vivek Muthurangu
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 6/2019
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-019-04393-6

Other articles of this Issue 6/2019

Pediatric Radiology 6/2019 Go to the issue

Original Article

Stressors contributing to burnout amongst pediatric radiologists: results from a survey of the Society for Pediatric Radiology

Original Article

Lower extremity endovenous reconstruction for symptomatic occlusive disease in pediatric patients: techniques, clinical outcomes, and long-term stent patencies

Original Article

Evaluation of incidental pelvic fluid in relation to physiological changes in healthy pubescent children using pelvic magnetic resonance imaging

Original Article

What’s missing? An analysis of pediatric radiology fellowship website utility and recruitment potential

Correction

Correction to: The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI

Original Article

Percutaneous treatment of ranulas: ultrasound-guided drainage with salivary gland chemical ablation