title: Analysis of heart period and arterial pressure variability in childhood hypertension: key role of baroreflex impairment.
abstract: 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 alpha: 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.
authors: Clinica Nefrologica, S. Gerardo Hospital, University of Milano Bicocca, Milan, Italy.
authors: Simonetta
authors: S
authors: Genovesi
authors: Federico
authors: F
authors: Pieruzzi
authors: Marco
authors: M
authors: Giussani
authors: Valentina
authors: V
authors: Tono
authors: Andrea
authors: A
authors: Stella
authors: Alberto
authors: A
authors: Porta
authors: Massimo
authors: M
authors: Pagani
authors: Daniela
authors: D
authors: Lucini
mesh_terms: D001341:Autonomic Nervous System / Q000502:physiology; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D011311:Pressoreceptors / Q000502:physiology