End organ damage in children with primary hypertension

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。家族性和纵向研究表明，成人高血压可能始于儿童晚期和青春期。虽然大多数10岁以下的儿童都有某种形式的潜在肾脏疾病，但原发性高血压是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、有高血压的家庭成员、胰岛素抵抗、低出生体重或胎儿生长迟缓以及自由饮食钠。因此，预防成人心血管疾病应该从儿童时期开始似乎是一种直觉。此外，高血压的存在对患有潜在肾脏疾病的个人有重大影响。目前，儿童高血压的诊断依赖于随机的血压读数，与基于人群的分布曲线相比，而不是结果衡量标准。最近，动态血压监测(ABPM)已成为一种有用的临床工具，可以更仔细地描述昼夜血压模式。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到睡眠下降的百分比。此外，还需要更灵敏的靶器官损伤标志物。虽然左心室重量增加和微量白蛋白排泄是临床上与靶器官损害相关的指标，但检测到微小的、潜在可逆的血管变化被认为是在明显的心脏或肾脏损害之前出现的。应聘者在过去的三年里一直致力于儿童高血压领域的研究，并打算完成流行病学和医学生物统计学的正式培训，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相结合，努力进一步确定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害。

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.