899
Arch. Biol. Sci., Belgrade, 67(3), 899-901, 2015 DOI:10.2298/ABS140228050H
INTRODUCTION
Essential hypertension (EH) in children is a distinct pathology with increasing prevalence nowadays. This is due to the synergic action of multiple risk factors involved. It is generally accepted that high blood pres-sure (HBP) represents the major cause of cardiovas-cular diseases (World Health Organization, 2002). The prevalence and rate of diagnosis of HBP in chil-dren appear to be on the rise, mainly due to infantile obesity (Sorof et al., 2004; Mohan et al., 2004). In this paper we will try to clarify the existing data on the management of essential hypertension in childhood, its pathology and management, mainly referring to the correlations between the different stages of hyper-tension and the individual values of birth weight and gestational age, in 60 children with essential hyper-tension, during a 4-year study at the St. Mary Emer-gency Clinical Hospital for Children in Iaşi, Romania.
MATERIALS AND METHODS
Patients
We studied all cases of essential hypertension admit-ted in a four-year period to the Saint Mary Emer-gency Clinical Hospital for Children. Blood pressure was measured using a standardized protocol. Before enrolment, written informed consent was obtained from the parents or guardians of the children. Of the 60 children enrolled after establishing a diagnosis of essential hypertension, 36 patients had a normal BMI, 14 children were classified as overweight hyperten-sive and 10 patients as obese hypertenhyperten-sive, accord-ing to the age and sex-specific cut-off points of child overweight and obesity defined by the International Obesity Task Force (Cole et al., 2000). None of the patients had received any treatment for the control of hypertension. Regarding weight at birth, the chil-dren were divided into 3 groups: group 1 consisted of
THE IMPACT OF BIRTH WEIGHT AND GESTATIONAL AGE ON THE MANAGEMENT
OF JUVENILE ESSENTIAL HYPERTENSION
Mihai Hogas1,2, Dragomir Serban1,*, Lacramioara Serban1, Simona Hogas1, Alin Ciobica3,4, Daniel Timofte1 and Evelina Moraru1,2
1 “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
2 Second Pediatric Clinic, St. Mary Emergency Clinical Hospital for Children, Iasi, Romania 3 “Alexandru Ioan Cuza” University, Iasi, Romania
4 Center of Biomedical Research of the Romanian Academy, Iasi Branch, Romania
*Corresponding author: ilserban1@yahoo.com
Abstract: Essential hypertension in children is a very important biological aspect in child pathology, caused by the synergic action of multiple risk factors, with an increasing prevalence. Since there is not much knowledge about juvenile essential hypertension in childhood, in this paper we will clarify the existing data about this pathology and its management, mainly by referring to the correlations during different stages. We found significant correlations between hypertension and the individual values of birth weight and gestational age, which suggest that there is an important relationship between birth weight and gestational age, as important biological markers vs. the different stages of essential hypertension.
900 Hogas et al.
children with a birth weight less than 2500 g, group 2 consisted of children with a birth weight more than 2500 g but less than 4000 g and the third group of children had a birth weight more than 4000 g.
RESULTS
In the investigated groups, three categories of chil-dren were identified according to gestational age: ges-tational age less than 37 weeks (stage 1) – 8 children (13.3%); gestational age greater than or equal to 37 weeks but less than 42 weeks (stage 2) − 47 children (78.3%) and gestational age greater than or equal to 42 weeks (stage 3) − 5 children (8.3%).
We focused our attention on the correlations be-tween the different stages previously described for hy-pertension and the individual values of weight at birth and gestational age. Regarding the correlations we ob-served between the stages of essential hypertension and the individual values for weight at birth of the children selected for this study, we observed a very significant negative correlation, as shown by the increased value of r coefficient (r=-0.423) and the decreased value of p=0.001. We also obtained a significant negative corre-lation between the individual values of gestational age, as expressed in weeks, and the established stages of es-sential hypertension: n=60, r=-0.321, p=0.012. In addi-tion, we observed very significant negative correlations between the stages of birth weight and gestational age and the stages of the essential hypertension, as follows: stages of birth weight vs. stages of hypertension (n=60, r=-0.495, p<0.0001) and stages of gestational age vs. stages of hypertension (n=60, r=-0.351, p<0.006).
DISCUSSION
High blood pressure is the major cause of cardio-vascular diseases. It was recently shown that arterial hypertension is the main cause of mortality in the world and the second cause of morbidity (after pre-maturity) in children (World Health Organization, 2002). It is thought that the prevalence and rate of diagnosis of juvenile hypertension appear to be in-creasing (Sorof et al., 2004). This is mainly due to the
growth in prevalence of infantile obesity but also to changes in dietary habits, reduction in physical activ-ity and increasing stress (Mohan et al., 2004). In terms of prematurity, a higher risk of essential hypertension after the age of 12 years was noted in children with a gestational age less than 37 weeks. Barker et al. (1989) showed an independent association between low birth weight and the risk of hypertension, while car-diovascular disease has been highlighted in multiple populations from different geographic areas (Lawlor et al., 2005; Nilsson et al., 1997; Curhan et al., 1996).
It is generally believed that there is an increased risk of developing essential hypertension in prema-turely born children. In a study published recently, Norman et al. (2010) revealed a higher total antioxi-dant status (TAS) by an average of 10 mmHg in ado-lescents and young adults prematurely born, when compared to those born at term. Additionally, pre-vious reports showed that unhealthy dietary habits, physical inactivity and childhood obesity are the main cause of essential hypertension in children (van Swi-jndregt et al., 1996).
An important aspect that could be relevant in the context of the present study could be the association between inflammation and the risk of hypertension. In our research over the last 4 years, it was found that for a C-reactive protein (CRP) concentration above 3.5 mg/l there is a significantly increased risk of de-veloping hypertension after the age 12. Moreover, re-cent epidemiological, clinical and experimental data suggest that CRP can directly influence atherogen-esis. These studies indicated that CRP elevated serum values are directly related to vascular atherosclerotic changes in children, independent of the presence of conventional risk factors (Hashimoto et al., 2001).
BIOMARkERS AND MANAgEMENT OF JuvENILE HyPERTENSION 901
CRP in the intercellular adhesion molecules (ICAM) adhesion molecule expression in the endothelial cells (Pasceri et al., 2000).
To conclude, we found significant correlations between birth weight and gestational age and the dif-ferent stages of juvenile essential hypertension.
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