Concentration Of Active Renin In Children With Primary Hypertension

Objective: Renin-angiotensin-aldosetone system (RAAS) is a key player in regulation of blood pressure, vascular resistance, and fluid and electrolyte balance. Thus, activation of RAAS is considered as one of potential steps in development of primary hypertension (PH). Literature data suggest that active renin (AR) concentration is a precise marker of RAAS activation. The objective of the study was to assess the AR concentration in children with primary hypertension. Design and method: In this single-center cross-sectional study we evaluated AR [pg/mL], BMI Z-score, peripheral and central pressure, blood pressure in ABPM, biochemical parameters, ultrasonographic kidney image and arterial damage (cIMT, AIx75HR, PWV, elasticity of common carotid artery by E-tracking) in 98 children with PH (14.83 ± 2.92 years) and 45 healthy children. Results: Children with PH compared to healthy children had significantly higher: AR concentration (median: 34.3 [IQR:24.38–64.94] vs. 24.94 [IQR:16.81–34.32] [pg/ml], p < 0.001), BMI Z-score, peripheral and central blood pressure, blood pressure in ABPM, also cIMT, PWV, and uric acid and triglycerides concentrations. In the whole group of 143 children AR correlated significantly (p < 0.05) with office systolic (r = 0.24) and diastolic (r = 0.22) blood pressure, neutrophil count (r = 0.17), total (r = 0.20) and HDL (r = 0.20) cholesterol, heart rate (r = 0.17) and systolic pressure load in ABPM (r = 0.19); in 98 children with PH AR correlated also with number of hypotensive drugs (r = 0.42) and right and left kidney length (r = -0.23; r = -0.25); in 51 children with newly diagnosed PH also with ABPM MAP 24 h Z-score (r = 0.35) and central mean pressure (r = 0.41). In children with newly diagnosed PH AR in patients with isolated systolic hypertension was significantly lower compared to patients with systolic and diastolic hypertension (26.16 [IQR: 18.60–34.16] vs. 37.79 [IQR:27.03–49.58], p = 0.014) and did not differ from AR in healthy children. Conclusions: In this single-center cross-sectional study we evaluated AR [pg/mL], BMI Z-score, peripheral and central pressure, blood pressure in ABPM, biochemical parameters, ultrasonographic kidney image and arterial damage (cIMT, AIx75HR, PWV, elasticity of common carotid artery by E-tracking) in 98 children with PH (14.83 ± 2.92 years) and 45 healthy children.