Hypertension (HTN) is a significant public health concern affecting individuals across all age groups, including those with and without disabilities. Among children and adolescents, particularly those with intellectual disabilities, the risk of HTN is heightened due to factors such as obesity, low physical activity, and comorbid conditions. Regular blood pressure (BP) monitoring is essential, considering the challenges in measurement accuracy among children with intellectual disabilities. Beyond traditional lifestyle modifications, individualized dietary interventions and structured physical activity programs play a fundamental role in HTN prevention and management. Additionally, optimizing sleep quality and addressing comorbidities are essential for improving long-term health outcomes. The updated recommendations emphasize a broader specialist involvement, including endocrinologists, nephrologists, cardiologists, and rehabilitation specialists, to ensure comprehensive care. The integration of these approaches, along with appropriate pharmacological strategies whenever necessary, is crucial for achieving health benefit. This article provides practical guidance for primary care providers, specialists, and caregivers, advocating for a collaborative, patient-centered approach to reducing cardiovascular risks and enhancing the quality of life for children with intellectual disabilities.

• Klíčová slova
• hypertension, intellectual disability, obesity, physical activity, recommendations, sleep,
• MeSH
• cvičení MeSH
• dítě MeSH
• hypertenze * epidemiologie   terapie   komplikace   patofyziologie   MeSH
• lidé MeSH
• mentální retardace * komplikace   epidemiologie   MeSH
• mladiství MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: While hypertension (HT) in pediatric patients is often secondary (SH), recent trends show a rise in primary hypertension (PH), which is associated with an increasing global prevalence of obesity. A relationship between serum uric acid and PH has also been suggested. Our study aimed to assess the etiology of HT and factors associated with PH in a large European cohort of children referred for HT based on office blood pressure (BP) measurements. METHODS: We performed a retrospective analysis of 2008 children aged 0-18 years (12.3 ± 4.9 years) diagnosed with HT. Patients were classified into white coat hypertension (WCH), PH, or SH groups based on office BP, 24-h ambulatory BP monitoring (ABPM) and clinical evaluation. Anthropometric, hemodynamic, and biochemical data were collected. RESULTS: Out of 2008 patients included in the analysis, 200 (10%) were excluded due to multifactorial HT diagnosis after kidney transplantation (KTx). Among the remaining patients HT was confirmed in 1260 (548 were classified as WCH). Of 1260 patients with HT: 49.3% had PH, while 50.7% SH, mainly secondary to renal parenchymal disease (43.5% of SH patients), aortic coarctation (20.7%), and renovascular HT (18%). Age > 12.5 years, obesity (BMI SDS (standard deviation score) ≥ 1.65), and serum uric acid > 4.8 mg/dL were identified as significant factors associated with PH. CONCLUSIONS: Our study provides valuable insights into the current etiology of pediatric HT and highlights the role of age, obesity, and uric acid level in the diagnosis of PH in children.

• Klíčová slova
• Hypertension etiology, Pediatric hypertension, Primary hypertension, Secondary hypertension, Serum uric acid,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Physical activity (PA) provides health benefits across the lifespan and improves many established cardiovascular risk factors that have a significant impact on overall mortality. However, discrepancies between self-reported and device-based measures of PA make it difficult to obtain consistent results regarding PA and its health effects. Moreover, PA may produce different health effects depending on the type, intensity, duration, and frequency of activities and individual factors such as age, sex, body weight, early life conditions/exposures, etc. Appropriate biomarkers relating the degree of PA level with its effects on health, especially in children and adolescents, are required and missing. The main objective of the INTEGRActiv study is to identify novel useful integrative biomarkers of PA and its effects on the body health in children and adolescents, who represent an important target population to address personalized interventions to improve future metabolic health. METHODS/DESIGN: The study is structured in two phases. First, biomarkers of PA and health will be identified at baseline in a core cohort of 180 volunteers, distributed into two age groups: prepubertal (n = 90), and postpubertal adolescents (n = 90). Each group will include three subgroups (n = 30) with subjects of normal weight, overweight, and obesity, respectively. Identification of new biomarkers will be achieved by combining physical measures (PA and cardiorespiratory and muscular fitness, anthropometry) and molecular measures (cardiovascular risk factors, endocrine markers, cytokines and circulating miRNA in plasma, gene expression profile in blood cells, and metabolomics profiling in plasma). In the second phase, an educational intervention and its follow-up will be carried out in a subgroup of these subjects (60 volunteers), as a first validation step of the identified biomarkers. DISCUSSION: The INTEGRActiv study is expected to provide the definition of PA and health-related biomarkers (PA-health biomarkers) in childhood and adolescence. It will allow us to relate biomarkers to factors such as age, sex, body weight, sleep behavior, dietary factors, and pubertal status and to identify how these factors quantitatively affect the biomarkers' responses. Taken together, the INTEGRActiv study approach is expected to help monitor the efficacy of interventions aimed to improve the quality of life of children/adolescents through physical activity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, Identifier NCT05907785.

• Klíčová slova
• adipokines, cardiorespiratory fitness, cytokines, integration analysis, metabolomics, miRNome, transcriptomics,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF REVIEW: The goal is to review masked hypertension (MH) as a relatively new phenomenon when patients have normal office BP but elevated out-of-office BP. Firstly, it was described in children in 2004. It has received increased attention in the past decade. RECENT FINDINGS: The prevalence of MH in different pediatric populations differs widely between 0 and 60% based on the population studied, definition of MH, or method of out-of-office BP measurement. The highest prevalence of MH has been demonstrated in children with chronic kidney disease (CKD), obesity, diabetes, and after heart transplantation. In healthy children but with risk factors for hypertension such as prematurity, overweight/obesity, diabetes, chronic kidney disease, or positive family history of hypertension, the prevalence of MH is 9%. In healthy children without risk factors for hypertension, the prevalence of MH is very low ranging 0-3%. In healthy children, only patients with the following clinical conditions should be screened for MH: high-normal/elevated office BP, positive family history of hypertension, and those referred for suspected hypertension who have normal office BP in the secondary/tertiary center.

• Klíčová slova
• ABPM, Ambulatory blood pressure monitoring, BP, Blood pressure, LVH, Left ventricular hypertrophy, MH, Masked hypertension,
• MeSH
• chronická renální insuficience * MeSH
• dítě MeSH
• hypertenze * diagnóza   epidemiologie   MeSH
• lidé MeSH
• maskovaná hypertenze * diagnóza   epidemiologie   MeSH
• mladiství MeSH
• obezita MeSH
• rizikové faktory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Impaired kidney concentration capacity is present in half of the patients with autosomal dominant polycystic kidney disease (ADPKD). The kidney concentrating capacity was further impaired within the animal model of autosomal recessive polycystic kidney disease (ARPKD). To date, only one small study has investigated it in children having ARPKD. Therefore, we aimed to study the kidney concentrating ability in a larger cohort of children with ARPKD. METHODS: Eighteen children (median age 8.5 years, range 1.3-16.8) were retrospectively investigated. A standardized kidney concentrating capacity test was performed after the application of a nasal drop of desmopressin (urine osmolality > 900 mOsmol/kg). The glomerular filtration rate was estimated using the Schwartz formula (eGFR) and blood pressure (BP) was measured as office BP. RESULTS: Kidney concentrating capacity was decreased (urine osmolality < 900 mOsmol/kg) in 100% of children with ARPKD. The median urine osmolality after desmopressin application was 389 (range 235-601) mOsmol/kg. Sixteen patients (89%) were defined as hypertensive based on their actual BP level or their use of antihypertensive drugs. The maximum amounts of urinary concentration correlated significantly with eGFR (r = 0.72, p < 0.0001) and hypertensive scores (r = 0.50, p < 0.05), but not with kidney size. Twelve patients (67%) were defined as having CKD stages 2-4. The median concentrating capacity was significantly lower in children within this group, when compared to children with CKD stage 1 possessing a normal eGFR (544 mOsmol/kg, range 413-600 mOsmol/kg vs. 327 mOsmol/kg, range 235-417 mOsmol/l, p < 0.001). CONCLUSIONS: Impaired kidney concentrating capacity is present in most children with ARPKD and is associated with decreased eGFR and hypertension. A higher resolution version of the Graphical abstract is available as Supplementary information.

• Klíčová slova
• Glomerular filtration rate, Hypertension, Kidney length, Pediatric population,
• MeSH
• chronická renální insuficience * komplikace   MeSH
• desmopresin MeSH
• dítě MeSH
• hodnoty glomerulární filtrace MeSH
• hypertenze * MeSH
• ledviny MeSH
• lidé MeSH
• polycystické ledviny autozomálně dominantní * MeSH
• polycystické ledviny autozomálně recesivní * komplikace   MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• desmopresin MeSH

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. Arterial hypertension is not only the most important risk factor for cardiovascular morbidity and mortality, but also the most important modifiable risk factor. Early hypertension-mediated organ damage may already occur in childhood. The duration of existing hypertension plays an important role in risk assessment, and structural and functional organ changes may still be reversible or postponed with timely treatment. Therefore, appropriate therapy should be initiated in children as soon as the diagnosis of arterial hypertension has been confirmed and the risk factors for hypertension-mediated organ damage have been thoroughly evaluated. Lifestyle measures should be recommended in all hypertensive children and adolescents, including a healthy diet, regular exercise, and weight loss, if appropriate. If lifestyle changes in patients with primary hypertension do not result in normalization of blood pressure within six to twelve months or if secondary or symptomatic hypertension or hypertension-mediated organ damage is already present, pharmacologic therapy is required. Regular follow-up to assess blood pressure control and hypertension-mediated organ damage and to evaluate adherence and side effects of pharmacologic treatment is required. Timely multidisciplinary evaluation is recommended after the first suspicion of hypertension. A grading system of the clinical evidence is included.

• Klíčová slova
• adolescents, blood pressure, children, hypertension, hypertension-mediated organ damage, monitoring, treatment,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.

• Klíčová slova
• adolescents, blood pressure, children, hypertension, monitoring,
• Publikační typ
• časopisecké články MeSH

The aim of this study was to investigate the tissue perfusion status and circadian rhythm in moderately premature infants. As a prospective study, from July 2019 to October 2019, the haemodynamic stability of moderate to late preterm, including such indicators as perfusion index (PI), blood pressure (systolic/diastolic) (BP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2) and body temperature were monitored in the morning and at night within eight days after birth. There was no difference of statistical significance between PI values in the morning and at night (P>0.05). The HR from days six to eight after birth was higher than days one to three (P<0.05). The HR increased significantly on days seven and eight compared with days four and five (P<0.05). The BP from days three to eight was significantly higher than on day one (P<0.05), and the BP from days four to eight was higher than on day two. There was a weak positive correlation between the PI values and gestational age (GA) (r=0.097), HR (r=0.067) and time (r=0.284), and a negative correlation with SpO2 (r=-0.113). The PI and HR of moderate to late preterm increased within eight days after birth. BP was relatively lower after birth and gradually increased to a stable level on days three to four. The PI and BP circadian rhythms associated with tissue perfusion were not established on day eight after birth.

• MeSH
• krevní tlak fyziologie   MeSH
• lidé MeSH
• novorozenec nedonošený * fyziologie   MeSH
• novorozenec MeSH
• perfuze MeSH
• prospektivní studie MeSH
• srdeční frekvence fyziologie   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: To date, our knowledge on antihypertensive pharmacological treatment in children and adolescents is still limited because there are few randomized clinical trials (CTs), hampering appropriate management. The objective was to perform a narrative review of the most relevant aspects of clinical trials carried out in primary and secondary hypertension. METHODS: Studies published in PubMed with the following descriptors: clinical trial, antihypertensive drug, children, adolescents were selected. A previous Cochrane review of 21 randomized CTs pointed out the difficulty that statistical analysis could not assess heterogeneity because there were not enough data. A more recent meta-analysis, that applied more stringent inclusion criteria and selected 13 CTs, also concluded that heterogeneity, small sample size, and short follow-up time, as well as the absence of studies comparing drugs of different classes, limit the utility. RESULTS: In the presented narrative review, including 30 studies, there is a paucity of CTs focusing only on children with primary or secondary, mainly renoparenchymal, hypertension. In trials on angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics, a significant reduction of both SBP and DBP in mixed cohorts of children with primary and secondary hypertension was achieved. However, few studies assessed the effect of antihypertensive drugs on hypertensive organ damage. CONCLUSIONS: Given the increasing prevalence and undertreatment of hypertension in this age group, innovative solutions including new design, such as 'n-of-1', and optimizing the use of digital health technologies could provide more precise and faster information about the efficacy of each antihypertensive drug class and the potential benefits according to patient characteristics.

• Klíčová slova
• adolescents, antihypertensive drug, children, clinical trial (2.172), pharmacological treatment,
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

BACKGROUND: Obesity and hypertension represent serious health issues affecting the pediatric population with increasing prevalence. Hypovitaminosis D has been suggested to be associated with arterial hypertension. Serotonin by modulating nitric oxide synthase affect blood pressure regulation. The biological mechanism by which vitamin D specifically regulates serotonin synthesis was recently described. The aim of this paper is to determine the associations between vitamin D, serotonin, and blood pressure in obese children. METHODS: One hundred and seventy-one children were enrolled in the prospective cross-sectional study. Two groups of children divided according to body mass index status to obese (BMI ≥95th percentile; n = 120) and non-obese (n = 51) were set. All children underwent office and ambulatory blood pressure monitoring and biochemical analysis of vitamin D and serotonin. Data on fasting glucose, insulin, HOMA, uric acid, and complete lipid profile were obtained in obese children. RESULTS: Hypertension was found only in the group of obese children. Compared to the control group, obese children had lower vitamin D and serotonin, especially in winter. The vitamin D seasonality and BMI-SDS were shown as the most significant predictors of systolic blood pressure changes, while diastolic blood pressure was predicted mostly by insulin and serotonin. The presence of hypertension and high-normal blood pressure in obese children was most significantly affected by vitamin D deficiency and increased BMI-SDS. CONCLUSIONS: Dysregulation of vitamin D and serotonin can pose a risk of the onset and development of hypertension in obese children; therefore, their optimization together with reducing body weight may improve the long-term cardiovascular health of these children.

• Klíčová slova
• Children, Hypertension, Obesity, Serotonin, Vitamin D,
• MeSH
• ambulantní monitorování krevního tlaku MeSH
• dítě MeSH
• hypertenze * epidemiologie   MeSH
• index tělesné hmotnosti MeSH
• inzulin MeSH
• inzulinová rezistence * MeSH
• lidé MeSH
• nedostatek vitaminu D * MeSH
• obezita dětí a dospívajících * komplikace   epidemiologie   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• serotonin MeSH
• vitamin D MeSH
• vitaminy MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• inzulin MeSH
• serotonin MeSH
• vitamin D MeSH
• vitaminy MeSH