Skip to main content
SpringerLink
Log in

Evaluation of endothelial dysfunction in hypertensive children and adolescents

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Atherosclerotic changes can be attributed to early endothelial damage in individuals with hypertension. We aimed to explore the relationship between endothelial dysfunction and hypertension in newly diagnosed children without end-organ damage, considering carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and functional capillaroscopy parameters. We also analyzed the differences between dipper and non-dipper patients.

Methods

In this cross-sectional study, 20 patients diagnosed with essential hypertension with no target organ damage, and 20 age and sex-matched healthy volunteers were enrolled. The patient group comprised newly diagnosed individuals not receiving antihypertensive treatment. Hypertensive patients were divided into two groups (dipper and non-dipper patients). The measurements of CIMT, brachial FMD, and functional capillaroscopy were performed before starting treatment.

Results

Among the patients, 11 were boys, and 9 were girls, with a median age of 16.0 (2.13) years. Of 20 hypertensive patients, 10 were dipper and 10 were non-dipper. Significant differences were observed between the hypertensive patients and controls in terms of CIMT (p = 0.04), brachial artery FMD (p = 0.02), and functional capillary density (p < 0.001). Hypertensive patients exhibited increased CIMT, reduced brachial artery FMD, and lower capillary density. However, there were no differences between dippers and non-dippers regarding age, sex, height SDS, weight SDS, CIMT SDS, brachial artery FMD, and capillary density.

Conclusions

Understanding the vascular consequences associated with essential hypertension emphasizes the importance of early detection and management of hypertension. Herein, we have effectively highlighted significant endothelial changes through the analysis of three parameters in newly diagnosed children without apparent target organ damage.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The data are available from the corresponding author upon request.

References

  1. Halbach SM, Flynn JT (2023) Childhood primary hypertension: not uncommon, not benign. Hypertension 80:1197–1198

    Article  CAS  PubMed  Google Scholar 

  2. Lurbe E, Torro MI, Alvarez J (2013) Ambulatory blood pressure monitoring in children and adolescents: coming of age? Curr Hypertens Rep 15:143–149

    Article  PubMed  Google Scholar 

  3. Cuspidi C, Sala C, Tadic M et al (2015) Non-dipping pattern and subclinical cardiac damage in untreated hypertension: a systematic review and meta-analysis of echocardiographic studies. Am J Hypertens 28:1392–1402

    Article  PubMed  Google Scholar 

  4. Eelen G, de Zeeuw P, Simons M, Carmeliet P (2015) Endothelial cell metabolism in normal and diseased vasculature. Circ Res 116:1231–1244

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gallo G, Volpe M, Savoia C (2021) Endothelial dysfunction in hypertension: current concepts and clinical implications. Front Med (Lausanne) 8:798958

    Article  PubMed  Google Scholar 

  6. Singh S, Kothari SS, Bahl VK (2004) Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J 56:613–617

    PubMed  Google Scholar 

  7. Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J (2002) Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 20:159–169

    Article  CAS  PubMed  Google Scholar 

  8. Ghiadoni L, Salvetti M, Muiesan ML, Taddei S (2015) Evaluation of endothelial function by flow mediated dilation: methodological issues and clinical importance. High Blood Press Cardiovasc Prev 22:17–22

    Article  CAS  PubMed  Google Scholar 

  9. Cutolo M, Smith V (2013) State of the art on nailfold capillaroscopy: a reliable diagnostic tool and putative biomarker in rheumatology? Rheumatology (Oxford) 52:1933–1940

    Article  PubMed  Google Scholar 

  10. Foster BJ, Mackie AS, Mitsnefes M et al (2008) A novel method of expressing left ventricular mass relative to body size in children. Circulation 27:2769–2775

    Article  Google Scholar 

  11. Neyzi O, Bundak R, Gokcay G et al (2015) Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 7:280–293

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric Hypertension (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007

    Article  PubMed  Google Scholar 

  13. Weber T, Wassertheurer S, Rammer M et al (2011) Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension 58:825–832

    Article  CAS  PubMed  Google Scholar 

  14. Basalely A, Hill-Horowitz T, Sethna CB (2023) Ambulatory blood pressure monitoring in pediatrics, an update on interpretation and classification of hypertension phenotypes. Curr Hypertens Rep 25:1–11

    Article  PubMed  Google Scholar 

  15. Jourdan C, Wuhl E, Litwin M et al (2005) Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 23:1707–1715

    Article  CAS  PubMed  Google Scholar 

  16. Celermajer DS, Sorensen KE, Gooch VM et al (1992) Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 340:1111–1115

    Article  CAS  PubMed  Google Scholar 

  17. Serne EH, Gans RO, ter Maaten JC et al (2001) Impaired skin capillary recruitment in essential hypertension is caused by both functional and structural capillary rarefaction. Hypertension 38:238–242

    Article  CAS  PubMed  Google Scholar 

  18. Serne EH, Gans RO, ter Maaten JC et al (2001) Capillary recruitment is impaired in essential hypertension and relates to insulin’s metabolic and vascular actions. Cardiovasc Res 49:161–168

    Article  CAS  PubMed  Google Scholar 

  19. Cheng C, Daskalakis C, Falkner B (2010) Association of capillary density and function measures with blood pressure, fasting plasma glucose, and insulin sensitivity. J Clin Hypertens (Greenwich) 12:125–135

    Article  CAS  PubMed  Google Scholar 

  20. Conkar S, Yilmaz E, Hacikara S, Bozabali S, Mir S (2015) Is daytime systolic load an important risk factor for target organ damage in pediatric hypertension? J Clin Hypertens (Greenwich) 17:760–766

    Article  PubMed  Google Scholar 

  21. Modena MG, Bonetti L, Coppi F, Bursi F, Rossi R (2002) Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol 40:505–510

    Article  PubMed  Google Scholar 

  22. Shimbo D, Grahame-Clarke C, Miyake Y et al (2007) The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort. Atherosclerosis 192:197–203

    Article  CAS  PubMed  Google Scholar 

  23. Yeboah J, Crouse JR, Hsu FC, Burke GL, Herrington DM (2007) Brachial flow-mediated dilation predicts incident cardiovascular events in older adults: the cardiovascular health study. Circulation 115:2390–2397

    Article  PubMed  Google Scholar 

  24. Jurko A Jr, Jurko T, Minarik M et al (2018) Endothelial function in children with white-coat hypertension. Heart Vessels 33:657–663

    Article  PubMed  Google Scholar 

  25. Evrengul H, Tanriverdi H, Kilic ID et al (2012) Aortic stiffness and flow-mediated dilatation in normotensive offspring of parents with hypertension. Cardiol Young 22:451–456

    Article  PubMed  Google Scholar 

  26. Lande MB, Carson NL, Roy J, Meagher CC (2006) Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension 48:40–44

    Article  CAS  PubMed  Google Scholar 

  27. Juonala M, Magnussen CG, Venn A et al (2010) Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: the cardiovascular risk in young finns study, the childhood determinants of adult health study, the Bogalusa heart study, and the Muscatine study for the international childhood cardiovascular cohort (i3C) consortium. Circulation 122:2514–2520

    Article  PubMed  Google Scholar 

  28. Junqueira CLC, Magalhaes MEC, Brandao AA et al (2018) Microcirculation and biomarkers in patients with resistant or mild-to-moderate hypertension: a cross-sectional study. Hypertens Res 41:515–523

    Article  CAS  PubMed  Google Scholar 

  29. Penna GL, Garbero Rde F, Neves MF, Oigman W, Bottino DA, Bouskela E (2008) Treatment of essential hypertension does not normalize capillary rarefaction. Clinics (Sao Paulo) 63:613–618

    Article  PubMed  Google Scholar 

  30. Ozen K, Karahan MZ (2023) Non-dipper blood pressure impact on coronary slow flow in hypertensive patients with normal coronary arteries. Cureus 15:e33356

    PubMed  PubMed Central  Google Scholar 

  31. Huang CCLH, Wu TC, Lin SJ, Chen JW (2009) Circadian variation of blood pressure is correlated to vascular endothelial function in nondiabetic essential hypertensives. Acta Cardiol Sin 25:134–141

    Google Scholar 

  32. Higashi Y, Nakagawa K, Kimura M et al (2002) Circadian variation of blood pressure and endothelial function in patients with essential hypertension: a comparison of dippers and non-dippers. J Am Coll Cardiol 40:2039–2043

    Article  PubMed  Google Scholar 

Download references

Funding

No financial support or funding was received for this paper.

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

    Kenan Doğan, Mehmet Baha Aytaç & Kenan Bek

  2. Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

    Eviç Zeynep Başar, Hüseyin Salih Güngör & Kadir Babaoğlu

  3. Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

    Nihal Şahin, Yunus Emre Bayrak & Hafize Emine Sönmez

Authors
  1. Kenan Doğan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eviç Zeynep Başar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Baha Aytaç
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nihal Şahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yunus Emre Bayrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenan Bek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hüseyin Salih Güngör
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hafize Emine Sönmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kadir Babaoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenan Doğan.

Ethics declarations

Ethical approval

The protocol of the study was approved by the Ethical Commission for Research from Kocaeli University School of Medicine (KÜ-GOKAEK-2023/03.07). Informed consent was obtained from all participants before the study.

Conflict of interest statement

The authors declare that there is no conflict of interest in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Large Language Models (LLMs) such as ChatGPT were not used in the study.

Supplementary information

Below is the link to the electronic supplementary material.

Graphical abstract (PPTX 229 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doğan, K., Başar, E.Z., Aytaç, M.B. et al. Evaluation of endothelial dysfunction in hypertensive children and adolescents. Pediatr Nephrol 39, 1193–1199 (2024). https://doi.org/10.1007/s00467-023-06205-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-023-06205-4

Keywords

Search

Navigation