End organ damage in children with primary hypertension

原发性高血压儿童的终末器官损害

• 批准号: 6919728
• 负责人: DEBORAH P JONES
• 金额: $ 10.8万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-27 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6919728
• 关键词: adolescence (12-20); antihypertensive agents; blood flow measurement; cardiovascular disorder prevention; cardiovascular disorder risk; clinical research; disease /disorder proneness /risk; electrocardiography; essential hypertension; human subject; human therapy evaluation; kidney disorder; kidney function; middle childhood (6-11); pathologic process; patient oriented research

DESCRIPTION (provided by applicant): Hypertension is a significant risk factor for cardiovascular and renal disease. Familial and longitudinal studies demonstrate that adult hypertension may begin in late childhood and adolescence. Although the majority of children under the age of ten years have some form of underlying renal disease, primary hypertension is the most common cause of elevated BP in the second decade of life. Risk factors for childhood essential hypertension include obesity, family members with hypertension, insulin resistance, low birth weight or intrauterine growth retardation and liberal dietary sodium. Therefore, it seems intuitive that prevention of adult cardiovascular disease should begin during childhood. In addition, the presence of hypertension has a major impact on the individual with underlying renal disease. Diagnosis of hypertension in children currently depends on casual BP readings as compared to population-based distribution curves rather than outcome measures. Recently, ambulatory BP monitoring (ABPM) has become a useful clinical tool to more carefully characterize diurnal BP patterns. Not only can the mean systolic and diastolic BP be measured, the percentage of elevated readings and awake to sleeping decline can be assessed. In addition, there is a need for more sensitive markers of target organ damage. Whereas increased left ventricular mass and microalbumin excretion are clinically relevant measures of target organ damage, detection of subtle, potentially reversible vascular changes are postulated to be present prior to overt cardiac or renal damage. The candidate has pursued the area of childhood hypertension for the past 3 years and intends to complete formal training in epidemiology and medical biostatistics to strengthen her clinical research skills. Combined with a focus on vascular biology, the candidate plans to interface current knowledge in the area of renal physiology and vascular biology with innovative clinical applications in an effort to further define the underlying mechanisms of childhood hypertension with the eventual goal of prevention of hypertension induced renal and cardiovascular damage.

描述（由申请人提供）： 高血压是心血管和肾脏疾病的重要危险因素。家族和纵向研究表明，成人高血压可能始于儿童晚期和青春期。尽管大多数十岁以下儿童患有某种形式的潜在肾脏疾病，但原发性高血压是生命第二个十年血压升高的最常见原因。儿童原发性高血压的危险因素包括肥胖、家庭成员患有高血压、胰岛素抵抗、低出生体重或宫内生长迟缓以及饮食中钠含量过多。因此，从直觉上看，成人心血管疾病的预防应该从儿童时期开始。此外，高血压的存在对患有潜在肾脏疾病的个体有重大影响。目前，儿童高血压的诊断取决于随机血压读数与基于人群的分布曲线的比较，而不是结果测量。最近，动态血压监测 (ABPM) 已成为一种有用的临床工具，可以更仔细地表征昼夜血压模式。不仅可以测量平均收缩压和舒张压，还可以评估读数升高和清醒时血压下降的百分比。此外，需要更灵敏的靶器官损伤标记物。虽然左心室质量和微量白蛋白排泄的增加是靶器官损伤的临床相关测量，但假设在明显的心脏或肾脏损伤之前就存在微妙的、潜在可逆的血管变化。该候选人在过去三年里一直致力于儿童高血压领域，并打算完成流行病学和医学生物统计学方面的正式培训，以加强她的临床研究技能。结合对血管生物学的关注，候选人计划将肾脏生理学和血管生物学领域的现有知识与创新的临床应用结合起来，以进一步明确儿童高血压的潜在机制，最终目标是预防高血压引起的肾脏和心血管损伤。