End organ damage in children with primary hypertension

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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.