Does overweight or obesity worsen the clinical course and blood pressure levels in children with arterial hypertension compared to normal body weight?
Obesity in children with arterial hypertension is associated with earlier disease onset and more severe blood pressure elevations during daily monitoring.
BACKGROUND : Essential arterial hypertension (AH) develops more often in children with accompanying risk factors — obesity, overweight, positive heredity and genetic predisposition. AIM : Study of peculiarities of arterial hypertension clinical course in adolescents with normal body weight, overweight and obesity. MATERIALS AND METHODS : The study was conducted on children with arterial hypertension who received treatment in two hospitals in Voronezh in 2016–2020. A retrospective analysis of the children’s case histories was carried out taking into account the anamnesis, clinical laboratory and instrumental examination data and the pharmacotherapy. Some children underwent polymerase chain reaction genetic testing to determine pathological alleles of genes regulating blood pressure (BP). RESULTS : 96 patients aged 9 to 17 took part in the study. The group with normal body weight included 38 children (39.6%), median age 16.4 (aged 10.7; 17.9), with overweight — 33 people (34.4%), median age 15.2 (aged 12.0; 17.9), with obesity — 25 children (26.0%), median age 14.5 (aged 9.2; 17.9). Obese children developed arterial hypertension at earlier age (p = 0.023). According to blood pressure daily monitoring (BPDM), pathological values of systolic blood pressure (SBP) during the day (above the 95th percentile) among children with normal body weight were observed in 17 patients (44.7%), with excess body weight — in 14 people (42.4%), with obesity — in 16 people (64%), p = 0.031. Accurate difference values between the groups were obtained in terms of time index (TI) of SBP at night (p = 0.006). Time index of diastolic BP during the day > 50% was observed only in the obese children group — 4 people (16%) (p = 0.042). Pathological alleles of the angiotensinogen gene (AGT: 704 T>C), aldosterone synthase gene (CYP11B2: -344 C>T) and endothelial nitrogen synthase type 3 (NOS3: -786 T> C) were identified most frequently during genetic testing in some patients. CONCLUSION : Children with obesity developed earlier arterial hypertension compared to the same-age children with normal body weight and more often had unfavorable type of arterial hypertension according to BPDM. These results can be used to choose individual therapy and to develop special attention as regards certain target organs damage.
Chubarov et al. (Mon,) studied this question.