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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 328-333

The Effects of Obesity, Gender, and Ethnic Group on Left Ventricular Hypertrophy and Geometry in Hypertensive Children: A Collaborative Study of the International Pediatric Hypertension Association

Coral Hanevold, MD*, Jennifer Waller, PhD{ddagger}, Stephen Daniels, MD, PhD§, Ronald Portman, MD|| and Jonathan Sorof, MD||

* Department of Pediatrics, Medical College of Georgia, Augusta, Georgia
{ddagger} Office of Biostatistics and Bioinformatics, Medical College of Georgia, Augusta, Georgia
§ Department of Pediatrics, Children’s Hospital Medical Center of Cincinnati, Cincinnati, Ohio
|| Department of Pediatrics, University of Texas-Houston Medical School, Houston, Texas

Objective. To determine the prevalence of left ventricular hypertrophy (LVH) in a multiethnic group of children and adolescents with hypertension.

Design/Methods. Pooled data from 1998 to 2001 from 3 sites belonging to the International Pediatric Hypertension Association were reviewed. Patients undergoing echocardiography to detect LVH as part of the evaluation for hypertension were included for analysis. Left ventricular mass was calculated from 2-dimensional guided M-mode echocardiographic measurements of the left ventricle. Left ventricular mass index (LVMI) was calculated as left ventricular mass/height2.7. LVH by adult criteria was defined as LVMI > 51 g/m2.7 and by pediatric criteria as LVMI > 38.6 g/m2.7. Left ventricle geometry was classified as concentric, concentric remodeling, eccentric, or normal.

Results. Data on 129 patients with a mean age of 13.6 ± 3.6 years were analyzed. The population was 67% male, 46.5% white, 38.0% African American, and 15.5% Hispanic. The prevalence of LVH was 15.5% using adult criteria and 41.1% using pediatric criteria. Increasing body mass index (BMI) was associated with a higher LVMI. Using either pediatric or adult criteria LVH was associated with BMI ≥95th percentile for age and gender. LVH and concentric hypertrophy were identified most frequently in Hispanic children.

Conclusions. LVH occurs commonly in children with hypertension and is associated with an increased BMI. LVH may be more prevalent in Hispanic children than in other ethnic groups. Prevention and treatment of obesity is important in reducing the cardiovascular risk for children with hypertension. Further evaluation of the frequency of LVH in multiethnic populations is needed.

Key Words: hypertension • obesity • left ventricular hypertrophy • echocardiography • children

Abbreviations: LVH, left ventricular hypertrophy • LVM, left ventricular mass • UT, University of Texas Houston • CHMC, Children’s Hospital Medical Center of Cincinnati • MCG, Medical College of Georgia • BMI, body mass index • LV, left ventricle • LVMI, LVM index • RWT, relative wall thickness • OR, odds ratio

Received for publication Feb 12, 2003; Accepted May 29, 2003.




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