Elevated blood pressure has been established as an important risk factor for the development of cardiovascular disease, morbidity and mortality. The major manifestations of end-organ pathology associated with hypertension include congestive heart failure, ischemic heart disease, stroke, and peripheral artery disease, including renal failure, ischemic heart disease, stroke, and peripheral artery disease, including renal failure and retinopathy. As blood pressure has been studied in children, it has become evident that adult essential hypertension and its complications may have origins in adolescence and childhood. Clinical observations have shown that some individuals with elevated blood pressure will develop one form of morbidity, while others develop a different form, and still others do not develop any complications. The reasons for this are unknown. Few studies have been done which attempt to delineate risk factors for the development of the different end-organ pathologies in hypertensive individuals. Two end-organ problems are particularly amenable to study in children. Ultrasound examination of the heart allows the non-invasive study of left ventricular hypertrophy which is an important precursor to the devlopment of congestive heart failure. Retinal examination by fundal photographs and fluorescein angiography allows the examination of the effects of elevated blood pressure on the vessels of the eye. The purpose of the proposed investigation is to 1) describe the distribution of left ventricular hypertrophy and retinal vascular abnormalities in a population of children aged five to 20 years with essential hypertension; 2) evaluate potential risk factors for the development of these end-organ complications in this population; 3) test the hypothesis that the risk factors have an antecedent-consequence relationship with the complications; and 4) compare the risk factors for the development of left ventricular hypertrophy and retinal vascular disease. The research plan consists of two phases. The first phase is designed to use cross-sectional and case-control methodology to evaluate a number of potential risk factors for these complications. The second phase will investigate the development of left ventricular hypertrophy, changes, in left ventricular function and retinal vascular disease, and the temporal relationship of these complications to the risk factors found to be important in the first phase, using a cohort design. The long-term objective of this research is to construct a causal model for the development of these end-organ complications.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HL001380-05
Application #
3081815
Study Section
(SRC)
Project Start
1984-07-01
Project End
1989-06-30
Budget Start
1988-07-01
Budget End
1989-06-30
Support Year
5
Fiscal Year
1988
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
Daniels, S R; Strife, C F; Dolan, L M et al. (1993) Distribution and correlates of creatinine clearance in children and adolescents with blood pressure elevation. J Pediatr 122:S68-73
Daniels, S R; Lipman, M J; Burke, M J et al. (1993) Determinants of retinal vascular abnormalities in children and adolescents with essential hypertension. J Hum Hypertens 7:223-8
Daniels, S R; Lipman, M J; Burke, M J et al. (1991) The prevalence of retinal vascular abnormalities in children and adolescents with essential hypertension. Am J Ophthalmol 111:205-8
Daniels, S D; Meyer, R A; Loggie, J M (1990) Determinants of cardiac involvement in children and adolescents with essential hypertension. Circulation 82:1243-8
Daniels, S R; Meyer, R A; Liang, Y C et al. (1988) Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. J Am Coll Cardiol 12:703-8
Litvack, F; Grundfest, W S; Goldenberg, T et al. (1988) Pulsed laser angioplasty: wavelength power and energy dependencies relevant to clinical application. Lasers Surg Med 8:60-5
Ross, R D; Daniels, S R; Dolan, L M et al. (1988) Determinants of plasma atrial natriuretic factor concentrations in congenital heart disease. Am J Cardiol 62:785-8
Ross, R D; Daniels, S R; Schwartz, D C et al. (1987) Plasma norepinephrine levels in infants and children with congestive heart failure. Am J Cardiol 59:911-4
Daniels, S R; Loggie, J M; Burton, T et al. (1987) Difficulties with ambulatory blood pressure monitoring in children and adolescents. J Pediatr 111:397-400
Cyran, S E; Hannon, D W; Daniels, S R et al. (1987) Predictors of postoperative ventricular dysfunction in infants who have undergone primary repair of a ventricular septal defect. Am Heart J 113:1144-8

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