Hypertension and left ventricular hypertrophy

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Left ventricular hypertrophy is well established as an important risk factor for cardiovascular disease in adults. It has also been found to be relatively common in children with hypertension. This raises the concern that children with hypertension may already be demonstrating evidence of adverse cardiovascular impact of their blood pressure elevation at a relatively young age. In this issue of The Journal, Brady et al studied children at their initial evaluation for blood pressure elevation. They found that 41% of these children already had left ventricular hypertrophy by echocardiography. These children were more likely than those without hypertrophy to also be obese, but did not differ in their level of casual blood pressure or their ambulatory blood pressure monitory results. This supports the recommendation that children with hypertension should have echocardiograms to evaluate left ventricular mass. It also suggests that children and adolescents may have a period of blood pressure elevation prior to diagnosis and that by the time the diagnosis is made, adverse cardiovascular effects may already be underway.