Echocardiography spots pediatric hypertension

Echocardiography has unearthed links among morbid pediatric obesity, sleep disorders, and potentially fatal pulmonary hypertension, according to a study presented at the 2006 American Society of Echocardiography meeting in Baltimore, Maryland.

Physicians have long known that obesity and sleep apnea go hand in hand. What they didn't know is that unsuspected abnormalities such as pulmonary hypertension sometimes belong in the equation.

Heart ultrasound can often detect these conditions in young patients, said principal investigator Dr. Monesha Gupta-Malhotra of the University of Texas Medical School at Houston.

Gupta-Malhotra and colleagues enrolled 143 children and young adults ages one to 19 years old with systemic hypertension. All underwent echocardiography for the diagnosis of end-organ damage. The researchers evaluated all studies for pulmonary artery pressures (PAP) equal to or larger than 40 mm Hg as measured by Doppler sonography.

After ruling out other causes, they found that a significant percentage of children with elevated PAP were morbidly obese. They also found a significant number of those children had sleep apnea.

The investigators detected elevated PAP in nine children (mean age 13.7 and mean PAP 43.5 mm Hg). Six of them had idiopathic systemic hypertension and were morbidly obese. Four had left ventricular hypertrophy and sleep disturbances. These children had had their tonsils and adenoids removed.

The researchers suggested the etiology of the elevated and potentially fatal blood pressure in the lungs of children with idiopathic systemic hypertension might be related to hypoxia induced from obstructive sleep apnea.

"This finding may lead to life-saving treatment," Gupta-Malhotra said.