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Evolution of arterial hypertensions in children over a 25-year follow-up period

Rumyana Rahneva, Elena Shipkovenska


The purpose of the study is to follow the evolution of primary arterial hypertension (PAH) established in childhood in a 25-year period until adulthood and to shed light on 3 questions: dynamics of arterial pressure; changes in target organs; role of some main risk factors for the development of arterial hypertension.

Material and methods: A prospective epidemiological study was conducted. The individual empirical information was collected in three consequtevie periods - in 1972-1973, 1982-1983 and 1997-1998. During the first stage, a cardiological screening and interview was conducted for 11,095 children aged 6-15, /a representative sample of the children living in the city of Sofia/. During the second stage, the evolution of PAH was followed in all children who showed increased arterial pressure in the first study. During the third stage /at the 25th year of the follow-up/, all persons with hypertension, established in the previous stages, who responded to the invitation (60.1%) were included. The examination was conducted according to a standard protocol: interview, physical examination, ECG, echocardiogram, biochemical analysis, fundoscopy. Statistical analysis includes: analysis of variance, correlation, t-test, Chi-square test, logistic regression analysis.


In the 11,095 children screened, aged 6-15, the following was found: arterial hypertension in 765 children - 6.89%; children with borderline hypertonia - 894 /8.06%/ and a group of hyperactive children - 1365 /12.33%/. All children from the three groups are practically healthy, with minimal vegetative dystonic complaints: irritability, headache, sweating, abdominal pain, poor sleep, etc. In the second study, a trend of retention of hypertension after 10 years was found in 111 persons with arterial hypertension registered during the screening, in 75 persons - with borderline values of arterial pressure and in 65 persons from the group of hyperactive children and normotonics, i.e. at the 10th year of follow-up, a total of 251 individuals remained with proven AH. When comparing the electrocardiographic, X-ray and the echocardiographic examination of the 10th year it was found that the echocardiographic examination has the greatest informativeness for early changes in the cardiovascular system.

At the 25th year of follow-up, a high relative share of boys who retained high blood pressure values in adulthood (78.70%) was noted, compared to girls - (46.00%). Left ventricular hypertrophy (LVH) was found in 59.34% of respondents; angioretinopathy I and II degree in 37.77%; elevated cholesterol level (³ 6.20 mmol/l) – 38.61%; reduced levels of HDL-cholesterol (£1.00 mmоl/l) – 26.26%; elevated triglyceride levels (³ 2.3 mmol/l) in 12.12%. The results of the multivariate logistic regression analysis performed to assess the risk factors for the maintenance of AH showed that hypertension is more common with a combination of the risk factors: family history of hypertension, male gender, obesity and increased salt intake (RR = 11.38; 95% CI 1.26 - 22.89).

Conclusion: PAH established in childhood persists in the following years of life until adulthood in one third of cases, with a slow course and progressive development of changes in the target organs. Main risk factors for the retention of AH are: family burden of AH, male gender, obesity and increased salt intake. These data indicate the need for strict control of body mass and nutrition in children with PAH who are offspring of hypertensive parents.


arterial hypertension, children, prospective, follow-up study

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G.S.Berenson, W.A. Wattigney, W. Bao et al. Rational to study the Early Nature History on Heart Disease: The Bogalusa Heart Study Am.J. Med. Sci, 1995, 310, 22-29.

Sadowski RH, Falkner B. Hypertension in pediatric patient. Am J Kidney Dis 1996;27 (3 : 305-315.

Р.Рахнева Епидемиологични проучвания на артериалните хипертонии и хипертонични реакции у деца от София на възраст от 6 до 15 години. Кандид. дис. София, 1975 .

Р.Рахнева Еволюция на артериалните хипертонии у децата в десетгодишен период. Докторска дис. София, 1988 .

R.W.Wissler. An overview of the Quatitative influence of Several Risk Factors on Progression of Atherosclerosis in Young People in the United States. Am.J.Med. Sci. 1995, 310 29-37.

Rahneva R.D,Belova DR, Petrova VS, Mihailova EM. Ten-Year Follow-Up Study of Children with Primary Hypertention from Sofia, Bulgaria. J Clin Hypertens 1987; 3; 713-718.

Jandova R, Vidimski J. Long term prognosis of juvenile hypertension over the 20-28 year. Cor et vasa 1983;5;340-350.

The Seventh Report of the Joint National Committee

Update on the 1987 Task Force on High Blood Preassure in Children and Adolescets: A Working Group Report from the National High Blood Pressure Education Program. Pediatrics, 1996, 98, 4, 649-658.

Uchiyama M. Risk factors to development of EH : long- term follow-up in junior hith school students in Niigata , Japan, J Hum Hypertens 1994;8; 5; 323-325.

Zweiker R., Eber B., Shumacher M., Toplak H., Klein W. "Non diping" related to cardiovassscular events in essential hypertensive patients. Acta Med. Austriaca 1994; 24(3): 86- 89.

Murdison KA., Treiber FA., Mensah GD., Deivis H., Thrompson W., Strong WB. Prediction of left ventricular mass in youth with family histories of essential hypertension. Am J Med Sci 1998] 315 (2): 118-123.

Daniels SR., Lipman M J., Burke MJ., Loogie JM. Determinants of retinal vascular abnormalities in children and adolescents with essential hypertension. J Hum Hypertens 1993] 7 (3) : 223-228.

Srinivasan SR ., Berenson GS. Childhood Lipoprotein Profiles and Implication for Adult Coronary Artery Disease: The Bogalusa Study. Am J Med Sci 1995; 310(Suppl 1): S62-S67.

Joshi S., S.Gupta, S.Tank et al Essential hypertension: antecedents in children. Indian Pediatr., 2003, 40 (1), 24-29.

Кlymbiene J., P, Silekine, Z. Milasauskiene et al. The relationship of childhood blood pressure: longitudinal study juvenile hypertension in Lithnania J.Hypertens, 2000, 18 (5) 531-538.

Webber LS, Wattigney WA., Srinvasan SR., Berenson GS. Obesity studies in Bogalusa. Am J Med Sci 1995] 310 (Suppl 1): 53 s-62 s.

Рахнева, Р., Е. Шипковенска, Т.Вълков, М.Вуков, М.Донева, Р.Шабани, В.Дишлянова, В.Петрова, К.Витлянова, Ч.Начев . Двадесет и пет годишно проследяване на деца с първични артериални хипертонии Обща медицина, 2004, 3, 18-25.

Rahneva R., E.Shipkovenska, R.Shabani. P.Docheva, B.Dishlianova, M.Vukov, K.Vitlianova, 25-years follow-up study on children with primary hypertension: Target-organ damage., San Francisco, USA, 2001.

Rahneva R., E.Shipkovenska, B.Dishlianova, R.Shabani. P.Docheva, M.Vukov, Ch.Naihev. Dislipidaemias in relation to personal history of prevalent hypertention, strok, coronary heart sisease and family history Chicago, USA, 2000.



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