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Intersection of Pediatric Hypertension and Cardiovascular-Kidney-Metabolic Disease
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DOI：10.1007/s11906-026-01375-6.png)
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Abstract
En 中文
The purpose of this review is to describe the intersection between pediatric hypertension and advancing stages of cardiovascular, kidney metabolic syndrome in children and adolescents. Cardiovascular-kidney-metabolic syndrome is highly prevalent in the pediatric population. The onset of CKM in childhood is influenced by the presence of antenatal risk factors such as maternal hypertensive disorders of pregnancy. Advancing stages of CKM in children and adolescents are strongly influenced by food insecurity and social determinants of health that impact the risk for childhood obesity. Activation of the renin-angiotensin-aldosterone system is a key mediator in the relationship between antenatal risk, early life course exposure and hypertension in children and adolescents. Effective strategies for slowing the rate of advancement of CKM staging in children and adolescents require attention to early course factors that influence the development of hypertension and obesity. Likewise, management strategies and therapeutic interventions that address these factors are critical to mitigating CKM stage advancement. Although hypertension is a component of the CKM framework, the presence of hypertension in children and adolescents drives higher CKM staging. Together, hypertension and higher CKM staging are associated with increased atherosclerotic cardiovascular disease risk. Social factors, including access to healthy foods and attention to early life course nutrition are critical strategies to improving CKM and hypertension related outcomes in children and adolescents.
Keywords:
AAP, american academy of pediatrics
ABPM, ambulatory blood pressure monitoring
ACEi, angiotensin-converting enzyme inhibitor
AHA, american heart association
ARB, angiotensin II receptor blocker
ASCVD, atherosclerotic cardiovascular disease
BAT, brown adipose tissue
BNP, brain natriuretic peptide
CHD, congenital heart disease
CKD, chronic kidney disease
CKM, cardiovascular-kidney-metabolic syndrome
CPG, clinical practice guideline
CRS, cardiorenal syndrome
DASH, dietary approaches to stopping hypertension
DOHaD, developmental origins of health and disease
EGF, epidermal growth factor
ER, endoplasmic reticulum
FFA, free fatty acids
GFR, glomerular filtration rate
HTG, hypertriglyceridemia
IL-18, interleukin-18
KIM-1, kidney injury molecule-1
MAP, mean arterial pressure
NGAL, neutrophil gelatinase-associated lipocalin
NHANES, national health and nutrition examination survey
NT-proBNP, N-terminal pro-B-type natriuretic peptide
PAI-1, plasminogen activator inhibitor 1
PVAT, perivascular adipose tissue
RAAS, renin-angiotensin-aldosterone system
ROS, reactive oxygen species
SGLT2, sodium-glucose co-transporter 2 protein inhibitor
SNS, sympathetic nervous system
SRP, negative social risk profile
T2DM, type 2 diabetes mellitus
TG, triglycerides
TNFR-1, -2, tumor necrosis factors1 and 2
UACR, urine albumin-creatinine ratio
VSMC, vascular smooth muscle cell
WAT, white adipose tissue
WCH, white coat hypertension
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