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Article ; Online: Hypertension in Children and Adolescents with Turner Syndrome (TS), Neurofibromatosis 1 (NF1), and Williams Syndrome (WS).

Sivasubramanian, Ramya / Meyers, Kevin E

2021 Volume 23, Issue 4, Page(s) 18

Abstract: Purpose of review: Turner syndrome (TS), neurofibromatosis type 1(NF1), and William Syndrome (WS) are 3 genetic conditions that are all associated with a substantial increase in risk of hypertension. In this review, we focus on factors leading to ... ...

Abstract	Purpose of review: Turner syndrome (TS), neurofibromatosis type 1(NF1), and William Syndrome (WS) are 3 genetic conditions that are all associated with a substantial increase in risk of hypertension. In this review, we focus on factors leading to hypertension and on clinical manifestations and management of hypertension in children and adolescents with these genetic conditions RECENT FINDINGS: In most instances, hypertension is secondary. There is a high prevalence of masked hypertension in TS; however, the extent to which control of the BP helps reduce the risk of aortic dissection/aneurysm in TS is not yet fully elucidated. Vasculopathies are the least emphasized but most important manifestation of NF1. Of note, routine screening for pheochromocytoma in NFI is not recommended as it is not cost-effective. Cardiovascular complications are the major cause of death in patients with WBS. ABPM identifies patients without overt aortic or renovascular narrowing. Antihypertensive agents such as ARBs that have direct vascular wall effects and agents that inhibit oxidative stress (minoxidil) should be considered, even in those who do not exhibit overt hypertension. Elevated blood pressure in children and adolescence manifests early with end-organ changes and when left untreated, increases risk for premature onset of cardiovascular disease. Vigilant monitoring of the blood pressure is recommended. Accurate early diagnosis and management of hypertension will delay or prevent target organ damage and ensure a healthier transition to adulthood among children afflicted with these conditions.
MeSH term(s)	Adolescent ; Adult ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Blood Pressure ; Child ; Humans ; Hypertension/complications ; Hypertension/drug therapy ; Neurofibromatosis 1/complications ; Turner Syndrome/complications ; Williams Syndrome/complications
Chemical Substances	Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors
Language	English
Publishing date	2021-03-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057367-4
ISSN	1534-3111 ; 1522-6417
ISSN (online)	1534-3111
ISSN	1522-6417
DOI	10.1007/s11906-021-01136-7
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Zs.A 5522: Show issues

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Article ; Online: Sleep-related breathing disorders and cardiometabolic risk factors in pediatric kidney transplant recipients.

Kuznetsova, Anna / Meyers, Kevin E / Dhanantwari, Preeta / Laney, Nina / Frank, Rachel / Sethna, Christine B

Pediatric transplantation

2022 Volume 26, Issue 8, Page(s) e14355

Abstract: Background: SRBDs have been shown to increase the risk of cardiovascular disease, which is a significant cause of mortality in kidney transplant recipients. Few studies have investigated the association between SRBDs and cardiometabolic risk factors in ... ...

Abstract	Background: SRBDs have been shown to increase the risk of cardiovascular disease, which is a significant cause of mortality in kidney transplant recipients. Few studies have investigated the association between SRBDs and cardiometabolic risk factors in pediatric kidney transplant recipients. Methods: This was a cross-sectional study of pediatric kidney transplant recipients using baseline cardiometabolic data from a previous clinical trial (NCT01007994). Parents/guardians of pediatric kidney transplant recipients filled out 22-item PSQ. A score greater than 33% was defined as a diagnosis of a SRBD. Fisher's exact test, Mann-Whitney U test, and regressions were used to determine associations. Results: Among the 58 transplant recipients enrolled, 14.80% (n = 8) of participants identified as Black and 40.7% (n = 22) were male. The median age was 13 (IQR 8.25, 17) years and median number of years post-transplant for participants was 2 (IQR 1, 4). The prevalence of SRBDs was 26% (n = 14). The presence of a SRBD was associated with abnormalities in multiple cardiometabolic risk factors including total cholesterol level (β = 23.63; 95% CI 3.58-43.67), LDL level (β = 24.94; 95% CI 6.37-43.50), triglyceride level (β = 54.62; 95% CI 8.74-100.50), and LVH (OR = 5.12; 95% CI 1.12-23.45) when adjusted for age, sex, and race. Conclusions: Similar to associations reported in the general pediatric and general CKD populations, SRBD is associated with increased cardiometabolic risk in pediatric kidney transplant recipients.
MeSH term(s)	Humans ; Child ; Male ; Adolescent ; Female ; Cross-Sectional Studies ; Cardiometabolic Risk Factors ; Transplant Recipients ; Kidney Transplantation/adverse effects ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Sleep ; Risk Factors
Language	English
Publishing date	2022-07-23
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1390284-2
ISSN	1399-3046 ; 1397-3142
ISSN (online)	1399-3046
ISSN	1397-3142
DOI	10.1111/petr.14355
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Zs.A 4947: Show issues

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Article ; Online: Association of Fibroblast Growth Factor 23 with Blood Pressure in Primary Proteinuric Glomerulopathies.

Pfaff, Mairead / Denburg, Michelle R / Meyers, Kevin E / Brady, Tammy M / Leonard, Mary B / Hoofnagle, Andrew N / Sethna, Christine B

American journal of nephrology

2023 Volume 55, Issue 2, Page(s) 187–195

Abstract: Introduction: Fibroblast growth factor 23 (FGF23) has direct effects on the vasculature and myocardium, and high levels of FGF23 are a risk factor for cardiovascular disease (CVD); however, the impact of FGF23 on CVD in primary proteinuric ... ...

Abstract	Introduction: Fibroblast growth factor 23 (FGF23) has direct effects on the vasculature and myocardium, and high levels of FGF23 are a risk factor for cardiovascular disease (CVD); however, the impact of FGF23 on CVD in primary proteinuric glomerulopathies has not been addressed. Methods: The associations of baseline plasma intact FGF23 levels with resting blood pressure (BP) and lipids over time among adults and children with proteinuric glomerulopathies enrolled in the Nephrotic Syndrome Study Network (NEPTUNE) were analyzed using generalized estimating equation regression analyses. Models were adjusted for age, sex, glomerular diagnosis, follow-up time, estimated glomerular filtration rate, urine protein/creatinine ratio, obesity, and serum phosphorous levels. Results: Two hundred and four adults with median FGF23 77.5 (IQR 51.3-119.3) pg/mL and 93 children with median FGF23 62.3 (IQR 44.6-83.6) pg/mL were followed for a median of 42 (IQR 20.5-54) months. In adjusted models, each 1 µg/mL increase in FGF23 was associated with a 0.3 increase in systolic BP index at follow-up (p < 0.001). Greater baseline FGF23 was associated with greater odds of hypertensive BP (OR = 1.0003; 95% CI 1.001-1.006, p = 0.03) over time. Compared to tertile 1, tertile 2 (OR = 2.1; 95% CI 1.12-3.99, p = 0.02), and tertile 3 (OR = 3; 95% CI 1.08-8.08, p = 0.04), FGF23 levels were associated with greater odds of hypertensive BP over time. Tertile 2 was associated with greater triglycerides compared to tertile 1 (OR = 48.1; 95% CI 4.4-91.9, p = 0.03). Conclusion: Overall, higher baseline FGF23 was significantly associated with hypertensive BP over time in individuals with proteinuric glomerulopathies. Further study of FGF23 as a therapeutic target for reducing CVD in proteinuric glomerular disease is warranted.
MeSH term(s)	Adult ; Child ; Humans ; Blood Pressure/physiology ; Fibroblast Growth Factor-23 ; Fibroblast Growth Factors ; Hypertension ; Cardiovascular Diseases ; Risk Factors
Chemical Substances	Fibroblast Growth Factor-23 (7Q7P4S7RRE) ; Fibroblast Growth Factors (62031-54-3)
Language	English
Publishing date	2023-12-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	604540-6
ISSN	1421-9670 ; 0250-8095
ISSN (online)	1421-9670
ISSN	0250-8095
DOI	10.1159/000535092
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Zs.A 1635: Show issues

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Article ; Online: Medication adherence in pediatric renal transplant patients: The role of family functioning and parent health locus of control.

Kraenbring, Meghan Marie / Zelikovsky, Nataliya / Meyers, Kevin E C

Pediatric transplantation

2019 Volume 23, Issue 2, Page(s) e13346

Abstract: Children and adolescents with renal disease experience daily social, emotional, and medical challenges. Renal transplantation can help to improve quality of life but requires a lifelong regimen of immunosuppressant medication to maintain health. ... ...

Abstract	Children and adolescents with renal disease experience daily social, emotional, and medical challenges. Renal transplantation can help to improve quality of life but requires a lifelong regimen of immunosuppressant medication to maintain health. Adherence to a daily complex regimen can be difficult, particularly for adolescents who are beginning to develop autonomy from caregivers and are faced with a unique set of socio-emotional challenges. This study examines two factors that have shown to influence adherence in other pediatric populations, namely family functioning and parent health locus of control, from mothers' perspectives, in predicting medication non-adherence for adolescents (ages 12-19 years) 1 year post-transplant. Non-adherence was defined as the percentage of missed doses and late doses of the weekly immunosuppressant doses prescribed. Regression results demonstrated that mothers' perceptions of poorer overall family functioning predicted missed medication doses (ΔR
MeSH term(s)	Adolescent ; Child ; Family Relations/psychology ; Female ; Graft Rejection/prevention & control ; Graft Rejection/psychology ; Humans ; Immunosuppressive Agents/therapeutic use ; Internal-External Control ; Kidney Transplantation ; Longitudinal Studies ; Male ; Medication Adherence/psychology ; Parents/psychology ; Young Adult
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2019-01-20
Publishing country	Denmark
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1390284-2
ISSN	1399-3046 ; 1397-3142
ISSN (online)	1399-3046
ISSN	1397-3142
DOI	10.1111/petr.13346
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Zs.A 4947: Show issues

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Article: Ambulatory Blood Pressure and Number of Subclinical Target Organ Injury Markers in Youth: The SHIP AHOY Study.

Hamdani, Gilad / Urbina, Elaine M / Daniels, Stephen R / Falkner, Bonita E / Ferguson, Michael A / Flynn, Joseph T / Hanevold, Coral D / Ingelfinger, Julie R / Khoury, Philip R / Lande, Marc B / Meyers, Kevin E / Samuels, Joshua / Mitsnefes, Mark

medRxiv : the preprint server for health sciences

2024

Abstract: Background: Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents.: ... ...

Abstract	Background: Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents. Methods: 244 participants (mean age 15.5±1.8 years, 60.1% male) were studied. Participants were divided based on both systolic clinic and ambulatory BP (ABP), into low- (<75 Results: 47.5% of participants had at least one TOI marker: 31.2% had one, 11.9% two, 3.7% three, and 0.8% four. The number of TOI markers increased according to the BP risk groups: the percentage of participants with more than one TOI in the low-, mid-, and high groups based on clinic BP was 6.7%, 19.1%, and 21.8% (p=0.02), and based on ABP was 9.6%, 15.8%, and 32.2% (p<0.001). In a multivariable regression analysis, both clinic BP percentile and ambulatory SBP index were independently associated with the number of TOI markers. When both clinic and ABP were included in the model, only the ambulatory SBP index was significantly associated with the number of markers. Conclusion: High SBP, especially when assessed by ABPM, was associated with an increasing number of subclinical cardiovascular injury markers in adolescents.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Preprint
DOI	10.1101/2024.03.15.24304137
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Article ; Online: Thinking under Pressure.

Meyers, Kevin E / Sethna, Christine B

The Journal of pediatrics

2016 Volume 180, Page(s) 7–10

MeSH term(s)	Blood Pressure ; Humans ; Hypertension ; Pressure
Language	English
Publishing date	2016-10-27
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2016.10.005
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Article ; Online: Association of neighborhood-level social determinants and food environments with pediatric hypertension care.

Min, Jungwon / Griffis, Heather M / Tam, Vicky / Meyers, Kevin E / Natarajan, Shobha S

Health & place

2020 Volume 65, Page(s) 102383

Abstract: Despite the apparent relationship between neighborhood characteristics and health, few studies of child health address neighborhood-level barriers, which may contribute to clinic no-show rates and difficulties following treatment plans in children and ... ...

Abstract	Despite the apparent relationship between neighborhood characteristics and health, few studies of child health address neighborhood-level barriers, which may contribute to clinic no-show rates and difficulties following treatment plans in children and youth. We used longitudinal data from an outpatient hypertension clinic to examine neighborhood social disorganization, built environments, and their associations with patients' clinic attendance and the risk of obesity/hypertension using mixed-effects regression models. Patients from disorganized neighborhoods were less likely to attend a baseline visit, and more likely to develop overweight/obesity and hypertension during follow-up. High-level fast-food expenditures in the neighborhood were associated with higher BMI percentiles and SBP during follow-up.
MeSH term(s)	Adolescent ; Ambulatory Care ; Fast Foods/adverse effects ; Female ; Humans ; Hypertension/diagnosis ; Longitudinal Studies ; Male ; No-Show Patients ; Residence Characteristics ; Social Determinants of Health
Language	English
Publishing date	2020-08-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1262540-1
ISSN	1873-2054 ; 1353-8292
ISSN (online)	1873-2054
ISSN	1353-8292
DOI	10.1016/j.healthplace.2020.102383
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Article ; Online: Hypertension: An Important But Reversible Cause of Systolic Dysfunction in a Cohort of Pediatric Patients.

Kamsheh, Alicia M / Meyers, Kevin E / Palermo, Robert A / Wu, Lezhou / Burstein, Danielle S / Edelson, Jonathan B / Lin, Kimberly Y / Maeda, Katsuhide / Rossano, Joseph W / Wittlieb-Weber, Carol A / O'Connor, Matthew J

Pediatric cardiology

2023 Volume 45, Issue 2, Page(s) 331–339

Abstract: Cardiac dysfunction due to hypertension (CDHTN) in pediatrics is not well described. We aimed to describe the presentation and outcomes of pediatric CDHTN and identify clinical features associated with resolution of dysfunction. A single-center ... ...

Abstract	Cardiac dysfunction due to hypertension (CDHTN) in pediatrics is not well described. We aimed to describe the presentation and outcomes of pediatric CDHTN and identify clinical features associated with resolution of dysfunction. A single-center retrospective cohort study of patients ≤ 21 years with CDHTN from January 2005-September 2020 was performed. Patients with systolic dysfunction without another cause, blood pressure > 95th percentile, and physician judgment that dysfunction was secondary to hypertension were included. Demographics, clinical characteristics, echocardiographic findings, and outcomes were examined using Fisher's exact and Mann-Whitney U tests. Multiple correspondence analysis was used to explore the relationship of resolution of dysfunction to clinical features. Thirty-four patients were analyzed at a median age of 10.9 (IQR 0.3-16.9) years. Patients were divided into groups < 1 year (n = 12) and ≥ 1 year (n = 22). Causes of hypertension were varied by age, with renovascular disease most common in infants (42%) and medical renal disease most common in older patients (77%). Echocardiography demonstrated mild LV dilation (median LV end-diastolic z-score 2.6) and mild LV hypertrophy (median LV mass z-score 2.4). Most patients (81%) had resolution of dysfunction, particularly infants (92%). One patient died and one patient was listed for heart transplant. None required mechanical circulatory support (MCS). No clinical features were statistically associated with resolution of dysfunction. Hypertension is an important but reversible cause of systolic dysfunction in children. Patients are likely to recover with low mortality and low utilization of MCS or transplantation. Further studies are needed to confirm features associated with resolution of dysfunction.
MeSH term(s)	Infant ; Humans ; Child ; Aged ; Child, Preschool ; Adolescent ; Retrospective Studies ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/etiology ; Hypertension/complications ; Cardiomyopathies/complications ; Echocardiography
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-023-03313-8
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Zs.A 1528: Show issues

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Article ; Online: C3 nephritic factors: A changing landscape.

Levy Erez, Daniella / Meyers, Kevin E / Sullivan, Kathleen E

The Journal of allergy and clinical immunology

2017 Volume 140, Issue 1, Page(s) 57–59

MeSH term(s)	Autoantibodies/immunology ; Complement C3 Nephritic Factor/immunology ; Complement C3 Nephritic Factor/metabolism ; Complement Pathway, Alternative/immunology ; Disease Susceptibility/immunology ; Glomerulonephritis, Membranous/diagnosis ; Glomerulonephritis, Membranous/etiology ; Glomerulonephritis, Membranous/metabolism ; Humans ; Lipodystrophy, Familial Partial/etiology ; Lipodystrophy, Familial Partial/metabolism ; Lipodystrophy, Familial Partial/pathology
Chemical Substances	Autoantibodies ; Complement C3 Nephritic Factor
Language	English
Publishing date	2017-03-16
Publishing country	United States
Document type	Editorial
ZDB-ID	121011-7
ISSN	1097-6825 ; 1085-8725 ; 0091-6749
ISSN (online)	1097-6825 ; 1085-8725
ISSN	0091-6749
DOI	10.1016/j.jaci.2017.02.018
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Uh III Zs.92: Show issues

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Article ; Online: Imaging studies in pediatric fibromuscular dysplasia (FMD): a single-center experience.

Louis, Robert / Levy-Erez, Daniella / Cahill, Anne Marie / Meyers, Kevin E

Pediatric nephrology (Berlin, Germany)

2018 Volume 33, Issue 9, Page(s) 1593–1599

Abstract: Background: Fibromuscular dysplasia (FMD) is a non-inflammatory vascular disease that in children unlike in adults shows no sex predilection. FMD is often underdiagnosed, and its pathophysiology is unclear. Delayed diagnosis may lead to refractory ... ...

Abstract	Background: Fibromuscular dysplasia (FMD) is a non-inflammatory vascular disease that in children unlike in adults shows no sex predilection. FMD is often underdiagnosed, and its pathophysiology is unclear. Delayed diagnosis may lead to refractory hypertension and decreases the chance of successful treatment. Doppler ultrasound (US), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and catheter-based angiography (angiography) are currently used to help make a clinicoradiological diagnosis of FMD. The main aim of the study was to compare the efficacy of imaging modalities which can allow for earlier and improved detection. Furthermore, an anatomical mapping of the location of lesions can help determine the best treatment modalities. Methods: All patients with non-syndromic non-inflammatory renovascular hypertension were recruited from the Nephrology Department at the Children's Hospital of Philadelphia (CHOP) and enrolled in the U.S. FMD Registry maintained at the University of Michigan. Clinical presentation and imaging findings on US, CT, and MRI of children diagnosed with FMD were evaluated. Results: Mean age at diagnosis was 7 ± 4.9 years (4 months-17 years). Family history of hypertension (HTN) (52%), FMD (8.7%), Caucasian (60%), headache (48%), and HTN (80%) were the most prevalent symptom and sign at presentation. Bruits were 100% specific for renal artery stenosis (RAS) diagnosis but were heard in the minority of patients (3 patients, 12%). FMD was mainly unifocal within a single site (68%) or multiple sites (28%) and involved the main or first order renal branch in about 68% of children. Isolated distal lesions beyond the second order branches were found in about 25% of children. US imaging was significantly less sensitive than angiography (28%, p = 0.003). MRA had a better sensitivity (62.5%, p = 0.3) than US. Overall, CTA had the best sensitivity (84.2%, p = 0.4) compared to angiography; however, only angiography showed distal vessel disease. Conclusions: Limitations of the study include the sample size and biases-only patients diagnosed with FMD were included in this study and most patients were referred to a pediatric nephrologist for unexplained hypertension. Angiography should be performed as part of the initial work-up of any child suspected of having renovascular FMD, regardless of the findings seen on US, MRA, or CTA.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Computed Tomography Angiography ; Cross-Sectional Studies ; Delayed Diagnosis ; False Negative Reactions ; False Positive Reactions ; Female ; Fibromuscular Dysplasia/complications ; Fibromuscular Dysplasia/diagnostic imaging ; Fibromuscular Dysplasia/pathology ; Humans ; Hypertension, Renovascular/diagnostic imaging ; Hypertension, Renovascular/etiology ; Hypertension, Renovascular/pathology ; Infant ; Magnetic Resonance Angiography ; Male ; Predictive Value of Tests ; Renal Artery/diagnostic imaging ; Renal Artery/pathology ; Renal Artery Obstruction/diagnostic imaging ; Renal Artery Obstruction/etiology ; Renal Artery Obstruction/pathology ; Sensitivity and Specificity ; Ultrasonography, Doppler
Language	English
Publishing date	2018-06-04
Publishing country	Germany
Document type	Comparative Study ; Evaluation Studies ; Journal Article
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-018-3983-6
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