Black children with primary hypertension (PHTN) are nearly twice as likely to
have left ventricular hypertrophy as children from other racial backgrounds with
PHTN, investigators reported here at the Pediatric Academic Societies 2009
Annual Meeting.

Cozumel S. Pruette, MD, pediatric nephrology fellow at Johns Hopkins Children's
Center, Baltimore, Maryland, and colleagues at 3 tertiary care medical centers
conducted a cross-sectional study of 139 children between the ages of 3 and 21
years presenting to their centers for evaluation of high blood pressure between
1997 and 2005. The children were eventually diagnosed with PHTN.

The investigators evaluated the children for left ventricular hypertrophy and
found an overall prevalence of 42%.

There were 35 black children in the cohort, 60% of whom had left ventricular
hypertrophy. Of the other 104 children in the cohort from other races, 37% had
left ventricular hypertrophy on presentation. The difference was significant (P
= .02).

The body mass index z-score was significantly higher in children with left
ventricular hypertrophy compared with those without it but was not significantly
different between the races (P = .4).

Total cholesterol was significantly elevated in black children with left
ventricular hypertrophy compared with black children without it. These
differences were not present among children of other races.

"Our study identifies black children with hypertension as a special group who
may be at particularly high risk for heart disease as they age because of
several risk factors, and pediatricians treating these kids should follow them
very closely," Dr. Pruette said.

"Children with left ventricular hypertrophy need more aggressive screening," she
told Medscape Pediatrics. "These children may possibly need earlier and more
aggressive pharmacologic treatment ¡X but this study doesn't address that.... We
will be looking at that in future studies," she added.

"These findings make sense," Robert M. Jacobson, MD, chairman of the Department
of Pediatrics at the Mayo Clinic in Rochester, Minnesota, commented in an
interview with Medscape Pediatrics. "We need to take a careful history and a
very careful physical assessment, evaluating these children for early signs of
cardiovascular disease.

"We know in adults that left ventricular hypertrophy is a marker of increased
cardiovascular morbidity and mortality," Dr. Jacobson said. "If we monitor these
children closely, we can detect signs of disease earlier.... We don't know yet
if early treatment of these children will reduce their risk. These studies are
ongoing."

Dr. Pruette has disclosed no relevant financial relationships. Dr. Jacobson
receives support as a member of Kaiser Permanente of Northern California's
Safety Review Committee for Gardasil Immunization, which he notes is not
relevant to this study.

Pediatric Academic Societies (PAS) 2009 Annual Meeting: Abstract 2530.6.
Presented May 2009