Hypertension impairs vascular reactivity in the pediatric brain
Hypertension impairs vascular reactivity in the pediatric brain
Background and Purpose- Chronic hypertension impairs cerebrovascular regulation in adults, but its effects on the pediatric population are unknown. The objective of this study was to investigate cerebrovascular abnormalities in hypertensive children and adolescents. Methods- Sixty-four children and adolescents aged 7 to 20 years underwent transcranial Doppler examinations of the middle cerebral artery at the time of rebreathing CO2. Time-averaged maximum mean cerebral blood flow velocity and end-tidal CO2 were used to quantify cerebrovascular reactivity during hypercapnia. Patients were clinically categorized as hypertensive, prehypertensive, or white coat hypertensive based on 24-hour ambulatory blood pressure measurements. Their reactivities were compared with 9 normotensive control subjects and evaluated against baseline mean blood pressure z-scores and loads. Results- Untreated hypertensive children had significantly lower hypercapnic reactivity than normotensive children (2.556±1.832 cm/s • mm Hg versus 4.256±1.334 cm/s • mm Hg, P<0.05). Baseline mean diastolic blood pressure z-scores (r=-0.331, P=0.037) and diastolic blood pressure loads (r=-0.351, P=0.026) were inversely related to reactivity. Conclusions- Untreated hypertensive children and adolescents have blunted reactivity to hypercapnia, indicating deranged vasodilatory reactivity. The inverse relationship between diastolic blood pressure indices and reactivity suggests that diastolic blood pressure may be a better predictor of cerebral end organ damage than systolic blood pressure.
cerebral blood flow, cerebrovascular reactivity, hypercapnia, hypertension, pediatric, transcranial Doppler
1834-1838
Wong, Linda J.
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Kupferman, Juan C.
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Prohovnik, Isak
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Kirkham, Fenella J.
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Goodman, Sharon
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Paterno, Kara
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Sharma, Madhu
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Brosgol, Yuri
af2f9f4b-c47d-4144-97cb-9bbb113fc725
Pavlakis, Steven G.
699873a7-5dc0-43b7-8d8a-b83e0253cbf8
July 2011
Wong, Linda J.
4e1bd479-0c62-4f70-a44d-befb12f7bae0
Kupferman, Juan C.
b9542b77-7076-47eb-b893-2565609e1fd0
Prohovnik, Isak
b67481c9-6a6d-4876-bbd7-a10e2f40d251
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Goodman, Sharon
93b93cb7-6c40-4c8c-ac55-6ef3471e414c
Paterno, Kara
c50cf703-9ad8-4c3d-909a-e99fc55c9b48
Sharma, Madhu
3769a6a5-40ef-42b4-9044-bc0fbf21a0ee
Brosgol, Yuri
af2f9f4b-c47d-4144-97cb-9bbb113fc725
Pavlakis, Steven G.
699873a7-5dc0-43b7-8d8a-b83e0253cbf8
Wong, Linda J., Kupferman, Juan C., Prohovnik, Isak, Kirkham, Fenella J., Goodman, Sharon, Paterno, Kara, Sharma, Madhu, Brosgol, Yuri and Pavlakis, Steven G.
(2011)
Hypertension impairs vascular reactivity in the pediatric brain.
Stroke, 42 (7), .
(doi:10.1161/STROKEAHA.110.607606).
Abstract
Background and Purpose- Chronic hypertension impairs cerebrovascular regulation in adults, but its effects on the pediatric population are unknown. The objective of this study was to investigate cerebrovascular abnormalities in hypertensive children and adolescents. Methods- Sixty-four children and adolescents aged 7 to 20 years underwent transcranial Doppler examinations of the middle cerebral artery at the time of rebreathing CO2. Time-averaged maximum mean cerebral blood flow velocity and end-tidal CO2 were used to quantify cerebrovascular reactivity during hypercapnia. Patients were clinically categorized as hypertensive, prehypertensive, or white coat hypertensive based on 24-hour ambulatory blood pressure measurements. Their reactivities were compared with 9 normotensive control subjects and evaluated against baseline mean blood pressure z-scores and loads. Results- Untreated hypertensive children had significantly lower hypercapnic reactivity than normotensive children (2.556±1.832 cm/s • mm Hg versus 4.256±1.334 cm/s • mm Hg, P<0.05). Baseline mean diastolic blood pressure z-scores (r=-0.331, P=0.037) and diastolic blood pressure loads (r=-0.351, P=0.026) were inversely related to reactivity. Conclusions- Untreated hypertensive children and adolescents have blunted reactivity to hypercapnia, indicating deranged vasodilatory reactivity. The inverse relationship between diastolic blood pressure indices and reactivity suggests that diastolic blood pressure may be a better predictor of cerebral end organ damage than systolic blood pressure.
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Accepted/In Press date: 14 January 2011
e-pub ahead of print date: 26 May 2011
Published date: July 2011
Keywords:
cerebral blood flow, cerebrovascular reactivity, hypercapnia, hypertension, pediatric, transcranial Doppler
Identifiers
Local EPrints ID: 429225
URI: http://eprints.soton.ac.uk/id/eprint/429225
ISSN: 0039-2499
PURE UUID: 2c3fd3c3-6cff-472b-b5dd-4ed15ef51851
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Date deposited: 22 Mar 2019 17:30
Last modified: 16 Mar 2024 03:22
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Contributors
Author:
Linda J. Wong
Author:
Juan C. Kupferman
Author:
Isak Prohovnik
Author:
Sharon Goodman
Author:
Kara Paterno
Author:
Madhu Sharma
Author:
Yuri Brosgol
Author:
Steven G. Pavlakis
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