Öz
Amaç: Primer hipertansiyon erişkin çağındaki kronik böbrek yetmezliği için başlıca risk faktörlerinden biridir. Esansiyel hipertansiyon sebepleri multifaktoriyeldir. Amacımız ambulatuar kan basıncı monitorizasyonu yapılmış primer hipertansiyon saptanan çocuklarda etyolojik faktörleri araştırmaktır.
Gereç ve Yöntem: Çalışmaya rutin sağlıklı çocuk kontrollerinde kan basınçları 90 persentilin üzerinde saptanan 56 çocuk ve kan basıncı 90 persentilin altında olan 27 sağlıklı çocuk alındı. Yirmi dört saatlik yaşam içi kan basıncı monitorizasyonu yapılarak gece gündüz kan basıncı ortalamaları, kan basıncı yükleri, dipper-non dipper özellikleri kaydedildi. Plazma renin aktivitesi, serum aldosteron, nitrik oksit, endotelin seviyeleri 24 saatlik idrarda sodyum ve potasyum atılımları karşılaştırıldı.
Bulgular: Laboratuvar değerlendirmelerinde hasta grupta kontrol gruba göre plazma renin aktivitesi yüksek, endotelin seviyesi düşük ve idrar sodyum atılımı yüksek saptandı.
Sonuç: Çocukluk çağı primer hipertansiyonu ve beyaz önlük hipertansiyonunda plazma renin düzeyinin ve idrar sodyum atılımının önemli rol oynadığı sonucuna varılmıştır.
Anahtar Kelimeler
Kaynakça
- Awazu M. Hypertension. Avner ED, HarmonWE, Niaudet P, Yoshikawa N. In Pediatric Nephrology, 6th ed. Berlin Heidelberg: Springer Springer Verlag, 2009:1457-541.
- Lurbe E, Alcon J, Redon J Hypertension. Geary DF, Schaefer F. [edited by]. In Comprehensive pediatric nephrology 1st edition Philedelphia, 2008;637-93.
- McNiece KL, Portman R. Hypertension In: Kher KK, Schnaper W, Makker SP (eds). Clinical Pediatric Nephrology, 2nd ed. Informa UK, 2007;459-90.
- Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab 2011;15 (4):367-73.
- Schiffrin EL. Endothelin: Potential role in hypertension and vascular hypertrophy. Hypertension 1995;25(6):1135-43.
- Nicolaidou P, Georgouli H, Matsinos Y, et al. Endothelin-1 in children with acute poststreptococcal glomerulonephritis and hypertension. Pediatr Int 2003;45(1):35-8.
- MacAllister R, Vallance P. Nitric oxide in essential and renal hypertension. J Am Soc Nephrol 1994;5(4):1057-65.
- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2):555-76.
- Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: A multicenter trial including 1141 subjects. J Pediatr 1997;130(2):178-84.
- Wühl E, Witte K, Soergel M, Mehls O, Schaefer F. German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: Normalized reference values and role of body dimensions. J Hypertens 2002;20(10):1995-2007.
- Lurbe E, Sorof JM, Daniels S. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 2004;144(1):7-16.
- Studer A, Lüscher T, Greminger P, et al. Blood pressure, renin angiotensin aldosterone system and other cardiovascular risk factors in children of essential hypertensives. Klin Wochenschr 1982;60(6):275-84.
- Martinez-Aguayo A, Aglony M, Campino C, et al. Aldosterone, plasma renin activity, and aldosterone/renin ratio in a normotensive healthy pediatric population. Hypertension 2010;56(3):391-6.
- Simões E Silva AC, Diniz JS, Regueira Filho A, Santos RA. Renin angiotensin system in childhood hypertension: Selective increase of angiotensin-(1-7) in essential hypertension. J Pediatr 2006;145(1):93-8.
- Baracco R, Kapur G, Mattoo T, et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens 2012;14(5):316-32.
- Akter S, Jesmin S, Iwashima Y, et al. Higher circulatory level of endothelin-1 in hypertensive subjects screened through a cross-sectional study of rural Bangladeshi women. Hypertens Res 2014;38(3):208-12.
- Gu X, Li H, Zhu X, et al. Inverse correlation between plasma adropin and ET-1 levels in essential hypertension: A cross-sectional study. Medicine 2015;94(40):1712.
- Schneider MP, Hilgers KF, Klingbeil AU, John S, Veelken R, Schmieder RE. Plasma endothelin is increased in early essential hypertension. Am J Hypertens 2000;13(6):579-85.
- Schiffrin EL, Deng LY, Sventek P, Day R. Enhanced expression of endothelin-1 gene in resistance arteries in severe human essential hypertension. J Hypertens 1997;15(1):57-63.
- Schiffrin EL, Larivière R, Li JS, Sventek P, Touyz RM. Deoxycorticosterone acetate plus salt induces overexpression of vascular endoelin-1 and severe vascular hypertrophy in spontaneously hypertensive rats. Hypertension 1995;25(4):769-73.
- Nar G, Soylu K, Akcay M, et al. Evaluation of the relationship between arterial blood pressure, aortic stiffness and serum endothelin-1 levels in patients with essential hypertension. Clin Exp Hypertens 2013;35(8):589-94.
- Klahr S. The role of nitric oxide in hypertension and renal disease progression. Nephrol Dial Transplant 2001;16(1):60-2.
- Goonasekera CD, Dillon MJ. Vascular endothelium and nitric oxide in childhood hypertension. Pediatr Nephrol 1998;12(8):676-89. 24. Hofman A, Hazebroek A, Valkenburg HA. A randomized trial of sodium intake and blood pressure in newborn infants. JAMA1983;250(3):370-3.
- Lifton RP. Molecular genetics of human blood pressure variation. Science 1996;272(5262):676-80.
- Soltysiak J, Skowronska B, Fichna P, et al. Urinary angiotensinogen and urinary sodium are associated with blood pressure in normoalbuminuric children with diabetes. Pediatr Nephrol 2014;29(12): 2373-8.
- Geleijnse JM, Grobbee DE, Hofman A. Sodium and potassium intake and blood pressure change in childhood. BMJ 1990;300(6729):899-902.
- Berry SE, Mulla UZ, Chowienczyk PJ, Sanders TA. Increased potassium intake from fruit and vegetables or supplements does not lower blood pressure or improve vascular function in UK men and women with early hypertension: A randomised controlled trial. Br J Nutr 2010;104(12):1839-47.
Öz
Aim: Primary hypertension is the most important risk factor for chronic kidney disease in adulthood. The genesis of essential hypertension is likely to be multifactorial. The aim of this study is to investigate the causing factors of primary hypertension detected by ambulatory blood pressure monitoring in children.
Materials and Methods: Fifty-six patients who had blood pressure higher than 90 percentile during the healthy children follow-up and 27 healthy children with the normal blood pressure were included in the study. Twenty-four hour blood pressure measurements with the blood pressure monitor were recorded as the day-night mean blood pressure, the blood pressure loads and the dipper-non-dipper characteristics. Plasma renin levels, serum aldosterone, nitric oxide and endothelin levels and amounts of sodium and potassium excretion in the 24 hour urine and were investigated in all patients and the control group.
Results: Laboratory evaluations of the patients showed that the patient group has higher mean levels of plasma renin, lower mean levels of blood endothelin and mean levels of urinary sodium excretion than the control group.
Conclusion: In the pathogenesis of childhood primary hypertension and white coat hypertension, which were seen in the half of the children diagnosed as primary hypertension, plasma renin and urinary sodium excretion had important roles.
Kaynakça
- Awazu M. Hypertension. Avner ED, HarmonWE, Niaudet P, Yoshikawa N. In Pediatric Nephrology, 6th ed. Berlin Heidelberg: Springer Springer Verlag, 2009:1457-541.
- Lurbe E, Alcon J, Redon J Hypertension. Geary DF, Schaefer F. [edited by]. In Comprehensive pediatric nephrology 1st edition Philedelphia, 2008;637-93.
- McNiece KL, Portman R. Hypertension In: Kher KK, Schnaper W, Makker SP (eds). Clinical Pediatric Nephrology, 2nd ed. Informa UK, 2007;459-90.
- Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab 2011;15 (4):367-73.
- Schiffrin EL. Endothelin: Potential role in hypertension and vascular hypertrophy. Hypertension 1995;25(6):1135-43.
- Nicolaidou P, Georgouli H, Matsinos Y, et al. Endothelin-1 in children with acute poststreptococcal glomerulonephritis and hypertension. Pediatr Int 2003;45(1):35-8.
- MacAllister R, Vallance P. Nitric oxide in essential and renal hypertension. J Am Soc Nephrol 1994;5(4):1057-65.
- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2):555-76.
- Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: A multicenter trial including 1141 subjects. J Pediatr 1997;130(2):178-84.
- Wühl E, Witte K, Soergel M, Mehls O, Schaefer F. German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: Normalized reference values and role of body dimensions. J Hypertens 2002;20(10):1995-2007.
- Lurbe E, Sorof JM, Daniels S. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 2004;144(1):7-16.
- Studer A, Lüscher T, Greminger P, et al. Blood pressure, renin angiotensin aldosterone system and other cardiovascular risk factors in children of essential hypertensives. Klin Wochenschr 1982;60(6):275-84.
- Martinez-Aguayo A, Aglony M, Campino C, et al. Aldosterone, plasma renin activity, and aldosterone/renin ratio in a normotensive healthy pediatric population. Hypertension 2010;56(3):391-6.
- Simões E Silva AC, Diniz JS, Regueira Filho A, Santos RA. Renin angiotensin system in childhood hypertension: Selective increase of angiotensin-(1-7) in essential hypertension. J Pediatr 2006;145(1):93-8.
- Baracco R, Kapur G, Mattoo T, et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens 2012;14(5):316-32.
- Akter S, Jesmin S, Iwashima Y, et al. Higher circulatory level of endothelin-1 in hypertensive subjects screened through a cross-sectional study of rural Bangladeshi women. Hypertens Res 2014;38(3):208-12.
- Gu X, Li H, Zhu X, et al. Inverse correlation between plasma adropin and ET-1 levels in essential hypertension: A cross-sectional study. Medicine 2015;94(40):1712.
- Schneider MP, Hilgers KF, Klingbeil AU, John S, Veelken R, Schmieder RE. Plasma endothelin is increased in early essential hypertension. Am J Hypertens 2000;13(6):579-85.
- Schiffrin EL, Deng LY, Sventek P, Day R. Enhanced expression of endothelin-1 gene in resistance arteries in severe human essential hypertension. J Hypertens 1997;15(1):57-63.
- Schiffrin EL, Larivière R, Li JS, Sventek P, Touyz RM. Deoxycorticosterone acetate plus salt induces overexpression of vascular endoelin-1 and severe vascular hypertrophy in spontaneously hypertensive rats. Hypertension 1995;25(4):769-73.
- Nar G, Soylu K, Akcay M, et al. Evaluation of the relationship between arterial blood pressure, aortic stiffness and serum endothelin-1 levels in patients with essential hypertension. Clin Exp Hypertens 2013;35(8):589-94.
- Klahr S. The role of nitric oxide in hypertension and renal disease progression. Nephrol Dial Transplant 2001;16(1):60-2.
- Goonasekera CD, Dillon MJ. Vascular endothelium and nitric oxide in childhood hypertension. Pediatr Nephrol 1998;12(8):676-89. 24. Hofman A, Hazebroek A, Valkenburg HA. A randomized trial of sodium intake and blood pressure in newborn infants. JAMA1983;250(3):370-3.
- Lifton RP. Molecular genetics of human blood pressure variation. Science 1996;272(5262):676-80.
- Soltysiak J, Skowronska B, Fichna P, et al. Urinary angiotensinogen and urinary sodium are associated with blood pressure in normoalbuminuric children with diabetes. Pediatr Nephrol 2014;29(12): 2373-8.
- Geleijnse JM, Grobbee DE, Hofman A. Sodium and potassium intake and blood pressure change in childhood. BMJ 1990;300(6729):899-902.
- Berry SE, Mulla UZ, Chowienczyk PJ, Sanders TA. Increased potassium intake from fruit and vegetables or supplements does not lower blood pressure or improve vascular function in UK men and women with early hypertension: A randomised controlled trial. Br J Nutr 2010;104(12):1839-47.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2018 |
| Gönderilme Tarihi | 29 Eylül 2016 |
| Yayımlandığı Sayı | Yıl 2018 |