An enlarged heart boosts the likelihood of death from heart disease in adults. Now it appears that 8% of children and teens with high blood pressure--perhaps one in 1250 in the United States--also have an ominous thickening of the heart muscle. The finding, reported in the latest issue of the journal Circulation, suggests that testing for heart enlargement should indicate which children need the most aggressive treatment for heart disease risk factors.
Heart enlargement--specifically of the heart's main pumping chamber, the left ventricle--was first linked to increased risk of fatal heart disease in 1990, as part of the massive Framingham heart disease study. Since then doctors have found that treating other heart disease risk factors, such as high blood pressure and obesity, can reduce relative left ventricle size.
Wondering how early in life this condition develops, cardiologist Stephen Daniels and his colleagues at the University of Cincinnati's Children's Hospital Medical Center surveyed 130 children who had been admitted to the hospital's high blood pressure clinic, and thus might be more likely to have an enlarged left ventricle. To calculate the relative size of each child's heart, the researchers scanned each heart with ultrasound. Eight percent of the children, who ranged in age from 6 to 23, met or exceeded the threshold that defines high risk in adults. "It is surprising because it suggests that this process is already occurring, and these children may be headed on paths for future cardiovascular disease," says Daniels.
Other cardiologists say the test should help guide treatment as well. Samuel Gidding of Northwestern University says the children with both high blood pressure and ventricle enlargement could be treated, not only with a weight loss program and healthier diet, but also with drugs that reduce blood pressure. "For this very small group of children who clearly have injury to their heart, we need to be more aggressive in treatment," he says.