Hypertension, Obesity, and Target Organ Injury in Children: An Emerging Health Care Crisis

Abstract

Purpose of review: To review data regarding the association between hypertension and childhood obesity on target organ damage. We will also review data regarding the impact of intervening on hypertension and childhood obesity on target organ damage.

Recent findings: The prevalence of hypertension and obesity are rising in children despite efforts to address these risk factors. Health disparities play a role in contributing to the rise in prevalence. Hypertension and obesity promote pro-inflammatory cytokines that activate the renin-angiotensin-aldosterone system and sympathetic nervous system which result in adverse effects on blood pressure regulation and renal function. Adverse cardiac, vascular, renal, neurocognitive, and retinal changes can be seen with elevated blood pressure. Recent intervention studies are few, but adequate treatment of hypertension and obesity can result in improvement in target organ damage. Hypertension and obesity have significant impacts upon target organs. Interventions to decrease blood pressure and treat obesity are associated with reductions in left ventricular hypertrophy, improvement in measures of systolic and diastolic function, and improvement in renal outcomes. Appropriate screening and management of these conditions can lessen potential future cardiovascular impact.

Keywords: Carotid intima media thickness; Left ventricular hypertrophy; Pediatric hypertension; Pediatric obesity; Pulse wave velocity; Target organ damage.

Fig. 1

Mechanisms of target organ damage from hypertension and obesity. Dotted arrow denotes possible effect BP = blood pressure; HR = heart rate; PVR = pulmonary vascular resistance; SV = stroke volume; RAAS = renin-angiotensin-aldosterone system; H₂O = water; Na⁺ = sodium