The development of end-organ pathology in primary hypertension is a multifactorial process. While blood pressure elevation clearly plays a role, other factors which are poorly understood, also appear to be involved. There have been few studies to determine these other factors in children and adolescents with essential hypertension. The principal investigator has recently completed a cross-sectional study of the correlates of left ventricular hypertrophy (determined by echocardiography), glomerular hyperfiltration measured by creatinine clearance, and retinal vascular abnormalities observed on photographs of the optic fundus in this population. This application proposes a prospective longitudinal study of children and adolescents with essential hypertension to investigate the temporal relationships between the change in potential risk factors (correlates) identified in the previous study and the development and progression of the target organ abnormalities. The risk factors associated with the development of end organ abnormalities in one organ system will be compared to the factors associated with abnormalities in the other organ systems. The proposed study will utilize a radioisotope study to determine glomerular filtration rate. This research will also test the hypotheses that left ventricular hypertrophy is detrimental to cardiac performance, and that the rate of urinary albumin excretion is correlated with glomerular filtration rate and is an indicator of nephrosclerosis. The ultimate goal of this investigation is to provide better understanding of the pathophysiologic processes involved in the development of heart, kidney and eye end-organ pathology. This may provide the basis for improved strategies to prevent target-organ abnormalities in children, adolescents and young adults with essential hypertension.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
2R01HL034698-05A1
Application #
3347884
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Project Start
1985-09-01
Project End
1994-06-30
Budget Start
1990-07-01
Budget End
1991-06-30
Support Year
5
Fiscal Year
1990
Total Cost
Indirect Cost
Name
Cincinnati Children's Hospital Medical Center
Department
Type
DUNS #
071284913
City
Cincinnati
State
OH
Country
United States
Zip Code
45229
de Simone, Giovanni; Daniels, Stephen R; Kimball, Thomas R et al. (2005) Evaluation of concentric left ventricular geometry in humans: evidence for age-related systematic underestimation. Hypertension 45:64-8
de Simone, G; Devereux, R B; Kimball, T R et al. (2001) Relation of heart rate to left ventricular dimensions in normotensive, normal-weight children, adolescents and adults. Ital Heart J 2:599-604
de Simone, G; Kimball, T R; Roman, M J et al. (2000) Relation of left ventricular chamber and midwall function to age in normal children, adolescents and adults. Ital Heart J 1:295-300
Young, L A; Kimball, T R; Daniels, S R et al. (1998) Nocturnal blood pressure in young patients with insulin-dependent diabetes mellitus: correlation with cardiac function. J Pediatr 133:46-50
Daniels, S R; Loggie, J M; Khoury, P et al. (1998) Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97:1907-11
Morrison, J A; Alfaro, M P; Khoury, P et al. (1996) Determinants of resting energy expenditure in young black girls and young white girls. J Pediatr 129:637-42
Daniels, S R; Kimball, T R; Khoury, P et al. (1996) Correlates of the hemodynamic determinants of blood pressure. Hypertension 28:37-41
Daniels, S R; Kimball, T R; Morrison, J A et al. (1995) Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 76:699-701
Daniels, S R; Kimball, T R; Morrison, J A et al. (1995) Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents. Statistical, biological, and clinical significance. Circulation 92:3249-54
Kimball, T R; Daniels, S R; Loggie, J M et al. (1993) Relation of left ventricular mass, preload, afterload and contractility in pediatric patients with essential hypertension. J Am Coll Cardiol 21:997-1001

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